Bone hemangioma is a type of hamartoma and a benign tumor. According to domestic data, spinal hemangiomas account for approximately 3% to 8.1% of primary spinal tumors, but the clinical detection rate is relatively low. The reasons may be that bone hemangiomas are benign, grow slowly, and early-stage patients are asymptomatic or have mild symptoms, leading to no medical consultation and thus remaining undetected. In advanced stages, when osteolytic changes are significant, patients are often misdiagnosed with metastatic cancer, leading to the abandonment of further examination and treatment. This disease commonly occurs in the spine and skull, with the cervical spine being less affected than the thoracic and lumbar spine. It is most common in middle-aged individuals around 40 years old, with a higher incidence in females than in males.

bubble_chart Pathological Changes

Bone hemangioma is a tumor-like proliferation of vascular tissue, interspersed between bone trabeculae, making it difficult to isolate. Histologically, it is divided into cavernous hemangioma and capillary hemangioma. The former is more common in the spine and skull, while the latter is more common in flat bones and the metaphysis of long tubular bones.

Gross appearance: The tumor tissue is grayish-red or dark red, prone to bleeding. The tumor causes bone expansion and thinning, and rough, sclerotic, irregular bone ridges are often seen on the tumor wall.

Microscopic appearance: The tissue of cavernous hemangioma mostly consists of densely packed thin-walled dilated blood vessels, belonging to capillaries or small veins, filled with red blood cells. Residual normal bone trabeculae may be seen at the tumor margin, and fatty bone marrow can be observed within the tumor tissue.

1. Patients generally experience mild pain and are in good overall condition. The symptoms and signs vary depending on the location of the tumor. Patients often only experience local grade I discomfort or grade I pain, and the condition is occasionally discovered through X-ray imaging. In severe cases, the disease can cause varying degrees of dysfunction in the limbs and sphincter. The reasons for spinal cord compression may include: (1) tumor spread to the epidural space; (2) expansion of the affected vertebral body causing spinal canal stenosis and deformation; (3) fracture and displacement of the affected vertebral body; (4) epidural hematoma caused by hemangioma bleeding.

2. X-ray findings: Based on the location of bone hemangioma invasion, it can be classified into vertebral type, vertebral arch type, and mixed type.

Vertebral type: The affected vertebral body is slightly expanded, showing typical palisade or mesh-like images, with many dense and clear vertical rough trabeculae within the low-density shadow. In the early stages of tumor development, the trabeculae formed are coarse, while in the advanced stage, they become finer.

Vertebral arch type: X-ray shows osteolytic changes in the pedicle or lamina, with blurred or disappeared images. However, the vertebral body and intervertebral space remain normal.

Mixed type: Refers to cases where the lesion involves both the vertebral body and vertebral arch. In addition to the X-ray findings of the above two types, there may also be pathological fracture of cervical vertebrae dislocation.

bubble_chart Diagnosis

The diagnosis is based on the patient's medical history, particularly the characteristics shown on X-ray films: thickening of the vertebral bone texture with a vertical, fence-like pattern; partial absorption of the bone texture forming a mesh-like, cystic appearance; slight expansion of the vertebral body or varying degrees of compression; and normal intervertebral spaces. When these typical X-ray imaging changes are present, the diagnosis is generally not difficult.

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For patients with cervical vertebral hemangiomas who are asymptomatic, no treatment is generally required, and only clinical dynamic observation is needed. If clinical symptoms are present, treatment is necessary.

Radiotherapy: It is generally believed that bone hemangiomas are grade II sensitive to radiotherapy. Its indications include: (1) patients who are not suitable for surgical treatment; (2) patients with incomplete surgical resection, using radiotherapy to eliminate residual tumor tissue. However, radiotherapy can damage the endothelial cells of spinal cord blood vessels, easily leading to thrombosis and potentially causing radiation myelitis. Therefore, careful consideration should be given when choosing this treatment.

Therapeutic selective stirred pulse embolization: This technique is more commonly used abroad. This procedure uses selective stirred pulse angiography to identify the blood vessels supplying the tumor and the spinal cord vessels, and then injects an embolic agent through a catheter inserted into the stirred pulse to embolize the blood vessels supplying the tumor, causing the tumor to shrink, relieving spinal cord compression, or reducing bleeding during tumor resection. This surgical technique requires high skill, and the key is to select which stirred pulse to embolize, otherwise, it may lead to vascular spinal cord injury.

Surgical treatment: When spinal cord compression is caused by bone hemangioma, surgical removal of the tumor and spinal canal decompression are effective treatment methods. However, this surgery involves significant bleeding, leading some scholars to hold different views. Therefore, thorough preparation should be made before surgery.