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Thoracic Spine Hemangioma

Hemangiomas are benign tumors composed of abnormal blood vessels. They can occur anywhere in the body but most commonly appear on the face, scalp or back. They can also occur in the vertebral bodies in the spine where they are referred to as vertebral hemangiomas. The vertebrae are the boney building blocks that stack one upon another that make up the spine.

What Is Hemangioma In The Thoracic Spine?

Vertebral hemangiomas are common benign vascular tumors of the spine. They have a prevalence of 10-12% in the general population and account for 2-3% of all spinal tumors (1). Most are asymptomatic and discovered incidentally on either an MRI or CT scan. 

Only 0.9-1.2 % of all vertebral hemangiomas expand and become symptomatic (2).  Pain and  nerve compression of nerves and spinal cord are common symptoms.

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Common Symptoms Of Hemangioma In The Thoracic Spine

Most vertebral hemangiomas are asymptomatic and cause no symptoms. Most are diagnosed in people within their 50s with a higher presence in females with a 1:1.5 male to female ratio.  Thoracic spine is the most common area of involvement.  They can involve a single or multiple vertebrae (3). 

The most common symptoms include:

Back Pain

Back pain can occur in patients with vertebral hemangiomas with varying intensity from mild to moderately severe. The pain is thought to be due to bleeding,  boney expansion secondary to tumor growth (4) or compression fracture(5). 

It is important to fully evaluate any patient with ongoing back pain with a known thoracic vertebral hemangioma. Other possible causes of back pain include thoracic disc, facet, ligament or costotransverse joint dysfunction which need to be evaluated.

Numbness

If the vertebral hemangioma grows,it can extend beyond the bone and encroach upon the spinal canal with irritation  or compression of  spinal nerves and or the spinal cord.  This nerve compression can result in numbness in the thoracic region or lower extremities.

Weakness

As described above, if the vertebral hemangiomas grows it can extend into the spinal canal with irritation or compression of the spinal cord or nerve roots.  This can lead to thoracic and lower extremity weakness.

Causes Of Hemangioma In Thoracic Spine

The exact cause of thoracic vertebral hemangiomas is not well understood.  Possible risk factors include:

  • Genetic Factors:  some evidence suggests that some patients may have a genetic predisposition.
  • Hormonal Factors: Hormones may play a role as thoracic vertebral hemangiomas occur more frequently in women and tend to enlarge during pregnancy. Pregnancy is the  one known risk factor for the development of neurologic symptoms (6)
  • Trauma:  some evidence suggest that trauma may trigger the development of these tumors.

Common Treatments For Thoracic Spine Hemangioma

Vertebral hemangiomas are common benign vascular tumors of the spine.  Most are asymptomatic and discovered incidentally..  Only 0.9-1.2 % of all vertebral hemangiomas expand and become symptomatic. Treatment options depend upon the symptoms and their severity.  

Treatment options for those patients with thoracic spine hemangiomas include the following.

Observation

Patients with minimal to mild pain can be followed with neurologic and radiographic examinations on a regular basis.

Pain Management

In the absence of any neurologic symptoms or signs of expansion, patients may be managed with oral analgesics, physical therapy, and lifestyle modifications.

Radiation Therapy

An effective treatment option for those patients with pain but no signs of spinal cord compression.  Radiation therapy uses high energy radiation to target and shrink the benign tumor thereby reducing pain (7).

Transarterial Embolization

A minimally invasive procedure that aims to reduce the blood flow to the hemangioma(8). This is achieved by advancing a catheter to the blood vessels that supply the hemangioma and then injecting embolic agents that block blood flow.

Surgery

Reserved for those patients with evidence of spinal cord compression that have not responded to conservative therapy including radiation and embolization. The specific type of surgery will depend upon many factors.  

Common surgeries for thoracic spine hemangiomas with evidence of spinal cord compromise include decompressive laminectomy, removal of vertebrae and spinal fusion

  • Vertebroplasty or Kyphoplasty: A minimally invasive procedure performed to stabilize the vertebral body and reduce pain.  Vertebroplasty involves injecting bone cement into the fractured or weakened vertebra (9), while kyphoplasty involves using a balloon-like device to create space and then filling it with bone cement.

Facet Joint Injections

A facet joint injection is a common medical procedure utilized in the diagnosis and treatment of facet joint injuries. It can be performed in the cervical, thoracic, and lumbar spine and may involve one or more facet joints. A facet injection involves the placement of a needle under an x-ray or ultrasound directly into the targeted facet joint and the administration of medication. The injected medicine goes directly into the joint and for this reason, some may refer to a facet injection as an intra-articular facet injection. Intra-articular refers to within the joint. The procedure can be diagnostic or therapeutic.

Read More About Facet Joint Injections

Prolotherapy For Thoracic Pain

Prolotherapy is an injection based regenerative therapy used in the treatment of ligament, tendon, muscle and spine injuries. It is minimally invasive and involves the injection of an irritant such as dextrose into the damaged or painful area. The injected irritant stimulates a delayed or frozen healing cycle thereby increasing blood flow and tissue healing. The thoracic spine is that section of the spine that is below the neck and above the low back. It is also referred to as the mid back. It has multiple components that include: Vertebral Bodies: Boney building blocks that stack one upon another…

Read More About Prolotherapy For Thoracic Pain

Prolotherapy Injections

It has been successful in the treatment of many disorders including neck, shoulder, knee, and ankle pain. Dr. Centeno recently published an article in The Journal of Prolotherapy in which he discusses the use of x-ray guidance with prolotherapy. This ensures that the injection is in the correct place to maximize clinical results. Dr. Centeno discusses the use of prolotherapy for the treatment of neck, knee, sacroiliac joint, ankle, ischial tuberosity, and shoulder pain. At the Centeno-Schultz Clinic x-ray guided prolotherapy is just one of the therapies utilized in the successful treatment of pain. Regenerative injection therapy (RIT) or prolotherapy…

Read More About Prolotherapy Injections

PRP Injections

PRP is short for platelet-rich plasma, and it is autologous blood with concentrations of platelets above baseline values. The potential benefit of platelet-rich plasma has received considerable interest due to the appeal of a simple, safe, and minimally invasive method of applying growth factors. PRP treatments are a form of regenerative medicine that utilizes the blood healing factors to help the body repair itself by means of injecting PRP into the damaged tissue. In regenerative orthopedics, it is typically used for the treatment of muscle strains, tears, ligament and tendon tears, minor arthritis, and joint instability. There have been more than 30 randomized controlled trials of PRP…

Read More About PRP Injections

Thoracic Spine Surgery

Thoracic spine surgery is a major surgery aimed at treating injuries in the thoracic spine. Because of the complex anatomy and close proximity to the heart and lungs, there are significant surgical risks and complications. Surgery on the thoracic spine can take hours and may require deflating the lung in order to gain access to the thoracic injury. Recovery can be lengthy depending upon the specific thoracic spine surgery performed. There are several different types of thoracic spine surgery.  The specific thoracic spine performed depends upon the underlying thoracic injury and a symptoms of the patient.  For example, a thoracic disc herniation…

Read More About Thoracic Spine Surgery

Make Educated Decisions About Your Condition

Hemangiomas are benign tumors composed of abnormal blood vessels. They can occur anywhere in the body including the spine. Vertebral hemangiomas are common benign vascular tumors of the spine.  They have a prevalence of 10-12% in the general population. Only 0.9-1.2 % of all vertebral hemangiomas expand and become symptomatic. 

Pain and neurologic symptoms such as weakness and numbness are common symptoms.  These symptoms are thought to occur due to bleeding, tumor expansion and compression of spinal nerves and in severe cases the spinal cord. The exact cause of thoracic vertebral hemangiomas is not well understood. 

Possible risk factors include genetic factors, hormonal factors, and trauma. Treatment when appropriate should always start with conservative therapy. Treatment options in patients with pain and or neurologic symptoms include observation, pain management, radiation, transarterial embolization, vertebroplasty or surgery.  

Prolotherapy and PRP injections can treat ligament instability, tendon inflammation and mild cases of spinal nerve irritation in patients with thoracic vertebral hemangiomas.

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Thoracic Spine Physician and Expert

John Schultz, MD

John R. Schultz M.D. is a national expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate and PRP for orthopedic injuries. He is board certified in Anesthesiology and Pain Medicine and underwent fellowship training. Dr. Schultz has extensive experience with same day as well as culture expanded bone marrow concentrate and sees patients at the CSC Broomfield, Colorado Clinic, as well the Regenexx Clinic in Grand Cayman. Dr. Schultz emphasis is on the evaluation and treatment of thoracic and cervical disc, facet, nerve, and ligament injuries including the non-surgical treatment of Craniocervical instability (CCI).

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Other Resources for Thoracic Spine Hemangioma

  • Understanding the Thoracic and Lumbar Spines

    The thoracic spine and lumbar spine make up a vital nexus of stability and mobility in the human body. In this exploration, we delve into the biomechanics and complexities that define these regions, unraveling their significance in posture, movement, and overall well-being.  Understanding the thoracic and lumbar spine not only illustrates the mechanics of our…

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    The spine, consisting of 33 individual bones called vertebrae, is divided into five major regions: cervical (neck), thoracic (upper back), lumbar (lower back), sacral (pelvic region), and coccygeal (tailbone). These vertebrae are separated by intervertebral discs, which act as cushions and allow for flexibility in movement. The lumbar spine, also known as the lower back,…

  • Understanding the Role Of The Thoracic Spine Muscles

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  • L5 S1 Or Lumbosacral Joint: What Is It And What Should You Be Wary Of?

    The L5 S1 joint, or the lumbosacral joint, is a critical joint. It lies between the lumbar segment of the spine and the auricular processes of the sacrum. The L5-S1 joint plays a vital role in transmitting the weight of the body via the sacrum and ilium downwards. The weight is distributed to the femur…

References:

  1. Nakahara M, Nishida K, Kumamoto S, Hijikata Y, Harada K. A case report of spondylectomy with circumference reconstruction for aggressive vertebral hemangioma covering the whole cervical spine (C4) with progressive spinal disorder. Eur Spine J. 2017 May;26(Suppl 1):69-74. doi: 10.1007/s00586-016-4765-0. Epub 2016 Sep 9. PMID: 27613010.
  2. Alexander J, Meir A, Vrodos N, Yau YH. Vertebral hemangioma: an important differential in the evaluation of locally aggressive spinal lesions. Spine (Phila Pa 1976). 2010 Aug 15;35(18):E917-20. doi: 10.1097/brs.0b013e3181ddfb24. PMID: 21381257.
  3. Gaudino S, Martucci M, Colantonio R, Lozupone E, Visconti E, Leone A, Colosimo C. A systematic approach to vertebral hemangioma. Skeletal Radiol. 2015 Jan;44(1):25-36. doi: 10.1007/s00256-014-2035-y. Epub 2014 Oct 28. PMID: 25348558.
  4. Leehey P, Naseem M, Every P, Russell E, Sarwar M. Vertebral hemangioma with compression myelopathy: metrizamide CT demonstration. J Comput Assist Tomogr. 1985 Sep-Oct;9(5):985-6. doi: 10.1097/00004728-198509000-00033. PMID: 4031184.
  5. Esparza J, Castro S, Portillo JM, Roger R. Vetebral hemangiomas: spinal angiography and preoperative embolization. Surg Neurol. 1978 Sep;10(3):171-3. PMID: 705602.
  6. Lavi E, Jamieson DG, Granat M. Epidural haemangiomas during pregnancy. J Neurol Neurosurg Psychiatry. 1986 Jun;49(6):709-12. doi: 10.1136/jnnp.49.6.709. PMID: 3734828; PMCID: PMC1028857.
  7. Faria SL, Schlupp WR, Chiminazzo H Jr. Radiotherapy in the treatment of vertebral hemangiomas. Int J Radiat Oncol Biol Phys. 1985 Feb;11(2):387-90. doi: 10.1016/0360-3016(85)90162-2. PMID: 3972655.
  8. Nair AP, Kumar R, Srivastav AK, Sahu RN, Kumar B. Outcome of dorsolumbar vertebral hemangiomas presenting with neuraxial compression. Indian J Orthop. 2012 Sep;46(5):536-41. doi: 10.4103/0019-5413.101033. PMID: 23162146; PMCID: PMC3491787.
  9. Narayana R, Pati R, Dalai S. Percutaneous vertebroplasty in painful refractory vertebral hemangiomas. Indian J Orthop. 2014 Mar;48(2):163-7. doi: 10.4103/0019-5413.128759. PMID: 24741138; PMCID: PMC3977372.

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