Spinal hemangioma

Diagnosis

A spinal hemangioma diagnosis typically starts with a physical exam and questions about your symptoms.

Your healthcare team orders imaging tests that may include X-rays, a CT scan and an MRI.

These tests can:

• Show the size and location of the spinal hemangioma.
• Help identify the type of spinal hemangioma. For example, typical spinal hemangiomas often show tiny dots or a vertical stripe pattern on CT and MRI imaging and look bright on an MRI because they contain a lot of fat mixed with blood vessels. Aggressive spinal hemangiomas may look dark on certain MRI images because they have less fat and more blood vessel tissue.

Healthcare professionals use images and symptoms to grade spinal hemangiomas. The grade describes how much of the spine bone is affected by the spinal hemangioma. This information helps your healthcare team know whether the spinal hemangioma is small or large, is weakening the bone, or is getting too close to the spinal cord and nerves.

The grading system ranges from 1 to 4:

Grade 1. A grade 1 spinal hemangioma is often found by accident when imaging is done for other reasons. Grade 1 means the spinal hemangioma affects less than half of the main part of one spine bone. The main part of the spine bone is also called the vertebral body.

Grade 2. A grade 2 spinal hemangioma affects more than half of the main part of one spine bone. If it doesn't cause symptoms, a healthcare professional may carefully monitor it to see whether it grows.

Grade 3. A grade 3 spinal hemangioma affects the whole main part of the spine bone. At this level, bones may weaken and the spinal hemangioma may require treatment.

Grade 4. Grade 4 means the spinal hemangioma has grown past the main part of the spine bone and is heading toward spaces near the spinal cord or nerves. At this level, the spinal hemangioma may press on nerves or on the spinal cord and may require surgery.

Treatment

Spinal hemangiomas typically do not need treatment if they are small and there are no symptoms. The type of treatment depends on the symptoms, how the spinal hemangioma looks on imaging, and whether it is pressing on the nerves or spinal cord.

If the spinal hemangioma is not causing symptoms, your healthcare team may carefully monitor it or you may be told to make an appointment if symptoms start.

If the spinal hemangioma looks suspicious, your healthcare professional may suggest a biopsy of the tumor to see whether it has cancer cells. A biopsy is a procedure to remove a sample of tissue for testing in a lab.

If the spinal hemangioma appears more aggressive or has a higher grade, is causing painful symptoms, or is pressing on your spinal cord or nerves, your healthcare team may suggest the following treatments:

• Vertebroplasty. A vertebroplasty is a treatment that injects cement into a cracked or broken spinal bone to help lessen pain.
• Corpectomy. A corpectomy is a surgical procedure in which the piece of the spinal bone that contains the hemangioma is taken out and then rebuilt.
• Sclerotherapy. Sclerotherapy is a procedure in which alcohol is injected into the spinal hemangioma to shrink it.
• Radiation. Radiation may be used when a spinal hemangioma is causing pain but is not causing nerve or spinal cord issues.

Healthcare professionals typically consider the part of the spine where your hemangioma is located when they make your treatment plan.

The main regions of the spine are:

• Cervical spine. The cervical spine is at the top of the spine. It runs from the base of the skull down to the base of the neck and upper shoulders. These spinal bones are labeled C1 through C7. Cervical-based spinal hemangiomas are usually harder to treat with vertebroplasty procedures. Surgery is usually favored in that area if there are severe symptoms.
• Thoracic spine. The thoracic spine is located in the middle part of the back. These spinal bones are labeled T1 through T12. If the spinal hemangioma causes pain in the thoracic spine and there are no spinal cord symptoms, treatment may include a vertebroplasty. If the spinal hemangioma is pressing on nerves or the spinal cord in this part of the spine, treatment may be surgery.
• Lumbar spine. The lumbar spine is located below the thoracic spine and above the pelvic area. These spinal bones are labeled L1 through L5. The transition zone between the thoracic and lumbar spine is called the thoracolumbar region. If the spinal hemangioma is located within the thoracolumbar area, it may be treated the same as thoracic-based spinal hemangiomas.

Prognosis

The prognosis for those with spinal hemangiomas is typically very good. Most spinal hemangiomas do not have symptoms. There are treatment options available for people who have painful or aggressive spinal hemangiomas.

Preparing for your appointment

If you have symptoms that worry you, make an appointment with a healthcare professional. If you have a spinal hemangioma, you will likely be referred to a specialist.

Specialists who care for people with spinal hemangiomas include:

• Healthcare professionals who diagnose and treat spinal cord conditions, called neurologists.
• Surgeons who operate on the spinal cord, called neurosurgeons.
• Healthcare professionals who diagnose and treat tumors that affect the bones, called orthopedic oncologists.
• Surgeons who operate on bones and joints, called orthopedic surgeons.
• Radiation oncologists who administer radiation therapy.
• Radiologists who may help give some treatments including vertebroplasty and sclerotherapy.

This information may help you get ready for your appointment.

What you can do

• Write down any symptoms you've been having and how long you've had them.
• List your key medical information, including all conditions you have and the names of any medicines you're taking. Include prescription medicines and medicines you buy without a prescription.
• Take a family member or friend along. Sometimes it can be hard to remember all the information provided to you during an appointment. Someone who goes with you may remember something that you miss or forget.
• Write down questions to ask your healthcare professional.

Questions to ask at your first appointment include:

• What may be causing my symptoms?
• Are there any other possible causes?
• What kinds of tests do I need? Do these tests require any special preparation?
• What do you recommend for next steps in determining my diagnosis and treatment?
• Should I see a specialist?

Questions to ask a neurologist include:

• Do I have a spinal hemangioma?
• What type of spinal hemangioma do I have?
• Will the spinal hemangioma grow over time?
• What might happen over time?
• What are the goals of my treatment?
• What treatment approach do you recommend?
• If the first treatment isn't successful, what can we try next?
• What is the outlook for my condition?
• Do I need a second opinion?

Don't hesitate to ask any other questions that may come up during your appointment.

What to expect from your doctor

Be prepared to answer questions about your symptoms and your health history. Questions may include:

• What are your symptoms?
• When did you first notice these symptoms?
• Have your symptoms become worse over time?
• If you have pain, where does the pain seem to start?
• Does the pain spread to other parts of your body?
• Have you done any activities that might explain the pain, such as a new exercise?
• Have you experienced any weakness or numbness in your legs?
• Have you had any trouble walking?
• Have you had any issues with your bladder or bowel function?
• Have you been diagnosed with any other medical conditions?
• Do you have any family history of noncancerous or cancerous tumors?