In Vertebral Hemangiomas with Neurological Deficit, Is a Less Extensive Approach Adequate
This was a retrospective study. To analyze the surgical and neurological outcomes following surgical decompression in patients with aggressive vertebral hemangioma (AVH) presenting with neurological deficit and to determine whether a less extensive approach is appropriate. AVHs are a rare subset of...
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Published in | Asian spine journal Vol. 17; no. 1; pp. 37 - 46 |
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Main Authors | , , , , , |
Format | Journal Article |
Language | English |
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Korea (South)
Korean Society of Spine Surgery
01.02.2023
Korean Spine Society |
Subjects | |
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Abstract | This was a retrospective study.
To analyze the surgical and neurological outcomes following surgical decompression in patients with aggressive vertebral hemangioma (AVH) presenting with neurological deficit and to determine whether a less extensive approach is appropriate.
AVHs are a rare subset of benign vascular tumors frequently presenting with neurological deficit because of spinal cord compression. Though the results of surgical management have improved over time, there is a lack of consensus on the ideal management in this group of patients.
Twenty-one patients who underwent surgery for AVH between 2009 and 2018 were analyzed. Demographic and clinical details of patients were retrieved from hospital information system. Imaging information (i.e., radiography, computed tomography, magnetic resonance imaging) of all patients was accessed and analyzed in picture archiving and communication system. Tumor staging was performed using Enneking and Weinstein-Boriani-Biagini classifications and Spinal Instability Neoplastic Score. At followup, neurological and radiological evaluations were performed.
Twenty-one patients (13 [61.9%] females and 8 [38.1%] males) were included with a mean age of 44.29 years (range, 14-72 years). All patients in the study had neurological deficit. Back pain was present in 80.9% of patients. Mean duration of symptoms was 4.6 months (range, 1 day to 10 months). Most common lesion location was thoracic spine (n=12), followed by thoracolumbar (D11- L2; n=7) and lumbar (n=2) regions. Ten patients had multiple level lesions. All patients underwent preoperative embolization. Nine patients underwent intralesional spondylectomy with reconstruction; another nine patients underwent stabilization, decompression, and vertebroplasty; three patients underwent decompression and stabilization. Neurology improved in all patients, and only one case of recurrence was noted in a mean follow-up of 55.78±25 months (range, 24-96 months).
In AVH, good clinical and neurological outcomes with low recurrence rates can be achieved using less extensive procedures, such as posterior instrumented decompression with vertebroplasty and intralesional tumor resection. |
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AbstractList | This was a retrospective study.
To analyze the surgical and neurological outcomes following surgical decompression in patients with aggressive vertebral hemangioma (AVH) presenting with neurological deficit and to determine whether a less extensive approach is appropriate.
AVHs are a rare subset of benign vascular tumors frequently presenting with neurological deficit because of spinal cord compression. Though the results of surgical management have improved over time, there is a lack of consensus on the ideal management in this group of patients.
Twenty-one patients who underwent surgery for AVH between 2009 and 2018 were analyzed. Demographic and clinical details of patients were retrieved from hospital information system. Imaging information (i.e., radiography, computed tomography, magnetic resonance imaging) of all patients was accessed and analyzed in picture archiving and communication system. Tumor staging was performed using Enneking and Weinstein-Boriani-Biagini classifications and Spinal Instability Neoplastic Score. At followup, neurological and radiological evaluations were performed.
Twenty-one patients (13 [61.9%] females and 8 [38.1%] males) were included with a mean age of 44.29 years (range, 14-72 years). All patients in the study had neurological deficit. Back pain was present in 80.9% of patients. Mean duration of symptoms was 4.6 months (range, 1 day to 10 months). Most common lesion location was thoracic spine (n=12), followed by thoracolumbar (D11- L2; n=7) and lumbar (n=2) regions. Ten patients had multiple level lesions. All patients underwent preoperative embolization. Nine patients underwent intralesional spondylectomy with reconstruction; another nine patients underwent stabilization, decompression, and vertebroplasty; three patients underwent decompression and stabilization. Neurology improved in all patients, and only one case of recurrence was noted in a mean follow-up of 55.78±25 months (range, 24-96 months).
In AVH, good clinical and neurological outcomes with low recurrence rates can be achieved using less extensive procedures, such as posterior instrumented decompression with vertebroplasty and intralesional tumor resection. STUDY DESIGNThis was a retrospective study. PURPOSETo analyze the surgical and neurological outcomes following surgical decompression in patients with aggressive vertebral hemangioma (AVH) presenting with neurological deficit and to determine whether a less extensive approach is appropriate. OVERVIEW OF LITERATUREAVHs are a rare subset of benign vascular tumors frequently presenting with neurological deficit because of spinal cord compression. Though the results of surgical management have improved over time, there is a lack of consensus on the ideal management in this group of patients. METHODSTwenty-one patients who underwent surgery for AVH between 2009 and 2018 were analyzed. Demographic and clinical details of patients were retrieved from hospital information system. Imaging information (i.e., radiography, computed tomography, magnetic resonance imaging) of all patients was accessed and analyzed in picture archiving and communication system. Tumor staging was performed using Enneking and Weinstein-Boriani-Biagini classifications and Spinal Instability Neoplastic Score. At followup, neurological and radiological evaluations were performed. RESULTSTwenty-one patients (13 [61.9%] females and 8 [38.1%] males) were included with a mean age of 44.29 years (range, 14-72 years). All patients in the study had neurological deficit. Back pain was present in 80.9% of patients. Mean duration of symptoms was 4.6 months (range, 1 day to 10 months). Most common lesion location was thoracic spine (n=12), followed by thoracolumbar (D11- L2; n=7) and lumbar (n=2) regions. Ten patients had multiple level lesions. All patients underwent preoperative embolization. Nine patients underwent intralesional spondylectomy with reconstruction; another nine patients underwent stabilization, decompression, and vertebroplasty; three patients underwent decompression and stabilization. Neurology improved in all patients, and only one case of recurrence was noted in a mean follow-up of 55.78±25 months (range, 24-96 months). CONCLUSIONSIn AVH, good clinical and neurological outcomes with low recurrence rates can be achieved using less extensive procedures, such as posterior instrumented decompression with vertebroplasty and intralesional tumor resection. Study Design This was a retrospective study. Purpose To analyze the surgical and neurological outcomes following surgical decompression in patients with aggressive vertebral hemangioma (AVH) presenting with neurological deficit and to determine whether a less extensive approach is appropriate. Overview of Literature AVHs are a rare subset of benign vascular tumors frequently presenting with neurological deficit because of spinal cord compression. Though the results of surgical management have improved over time, there is a lack of consensus on the ideal management in this group of patients. Methods Twenty-one patients who underwent surgery for AVH between 2009 and 2018 were analyzed. Demographic and clinical details of patients were retrieved from hospital information system. Imaging information (i.e., radiography, computed tomography, magnetic resonance imaging) of all patients was accessed and analyzed in picture archiving and communication system. Tumor staging was performed using Enneking and Weinstein–Boriani–Biagini classifications and Spinal Instability Neoplastic Score. At follow-up, neurological and radiological evaluations were performed. Results Twenty-one patients (13 [61.9%] females and 8 [38.1%] males) were included with a mean age of 44.29 years (range, 14–72 years). All patients in the study had neurological deficit. Back pain was present in 80.9% of patients. Mean duration of symptoms was 4.6 months (range, 1 day to 10 months). Most common lesion location was thoracic spine (n=12), followed by thoracolumbar (D11–L2; n=7) and lumbar (n=2) regions. Ten patients had multiple level lesions. All patients underwent preoperative embolization. Nine patients underwent intralesional spondylectomy with reconstruction; another nine patients underwent stabilization, decompression, and vertebroplasty; three patients underwent decompression and stabilization. Neurology improved in all patients, and only one case of recurrence was noted in a mean follow-up of 55.78±25 months (range, 24–96 months). Conclusions In AVH, good clinical and neurological outcomes with low recurrence rates can be achieved using less extensive procedures, such as posterior instrumented decompression with vertebroplasty and intralesional tumor resection. Study Design: This was a retrospective study.Purpose: To analyze the surgical and neurological outcomes following surgical decompression in patients with aggressive vertebral hemangioma (AVH) presenting with neurological deficit and to determine whether a less extensive approach is appropriate.Overview of Literature: AVHs are a rare subset of benign vascular tumors frequently presenting with neurological deficit because of spinal cord compression. Though the results of surgical management have improved over time, there is a lack of consensus on the ideal management in this group of patients.Methods: Twenty-one patients who underwent surgery for AVH between 2009 and 2018 were analyzed. Demographic and clinical details of patients were retrieved from hospital information system. Imaging information (i.e., radiography, computed tomography, magnetic resonance imaging) of all patients was accessed and analyzed in picture archiving and communication system. Tumor staging was performed using Enneking and Weinstein–Boriani–Biagini classifications and Spinal Instability Neoplastic Score. At followup, neurological and radiological evaluations were performed.Results: Twenty-one patients (13 [61.9%] females and 8 [38.1%] males) were included with a mean age of 44.29 years (range, 14–72 years). All patients in the study had neurological deficit. Back pain was present in 80.9% of patients. Mean duration of symptoms was 4.6 months (range, 1 day to 10 months). Most common lesion location was thoracic spine (n=12), followed by thoracolumbar (D11– L2; n=7) and lumbar (n=2) regions. Ten patients had multiple level lesions. All patients underwent preoperative embolization. Nine patients underwent intralesional spondylectomy with reconstruction; another nine patients underwent stabilization, decompression, and vertebroplasty; three patients underwent decompression and stabilization. Neurology improved in all patients, and only one case of recurrence was noted in a mean follow-up of 55.78±25 months (range, 24–96 months).Conclusions: In AVH, good clinical and neurological outcomes with low recurrence rates can be achieved using less extensive procedures, such as posterior instrumented decompression with vertebroplasty and intralesional tumor resection. |
Author | K S, Sri Vijay Anand Kavishwar, Rohit K, Guna Pratheep Kanna, Rishi Mugesh Shetty, Ajoy Prasad Rajasekaran, Shanmuganathan |
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Cites_doi | 10.1016/j.jocn.2010.05.022 10.1016/j.amsu.2017.12.001 10.3171/jns.1993.78.1.0036 10.1007/s00234-009-0520-0 10.4184/asj.2015.9.3.483 10.1016/j.nec.2007.09.010 10.12659/ajcr.898562 10.1179/016164104773026516 10.1016/j.spinee.2017.11.003 10.1097/00007632-200004150-00005 10.1016/j.nec.2007.10.005 10.4103/0973-1482.65248 10.1016/s0936-6555(05)80151-7 10.1097/brs.0000000000002973 10.3174/ajnr.a1010 10.1016/j.jocn.2006.06.004 10.1016/j.spinee.2013.07.450 10.4103/ajns.ajns_291_20 10.1016/j.ijrobp.2009.04.055 10.7461/jcen.2013.15.4.320 10.3109/02841868509134375 10.1177/145749691110000210 |
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Keywords | Intralesional spondylectomy Embolization Vertebroplasty Vertebral hemangioma Decompression Surgical treatment |
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References | ref13 Song (ref21) 2012 ref12 ref15 ref14 Fletcher (ref1) 2006 Ji (ref30) 2020 ref17 ref16 ref19 ref18 ref24 ref23 ref26 ref25 ref20 Boriani (ref2) 1997 Cotten (ref10) 1996 Acosta (ref11) 2011 ref27 ref29 ref8 ref7 ref9 ref4 Goldstein (ref31) 2015 ref3 ref6 ref5 Fisher (ref22) 2010 Deramond (ref28) 1998 |
References_xml | – start-page: E67 volume-title: Surgical management of Enneking stage 3 aggressive vertebral hemangiomas with neurological deficit by one-stage posterior total en bloc spondylectomy: a review of 23 cases year: 2020 ident: ref30 contributor: fullname: Ji – ident: ref27 doi: 10.1016/j.jocn.2010.05.022 – ident: ref26 doi: 10.1016/j.amsu.2017.12.001 – ident: ref3 doi: 10.3171/jns.1993.78.1.0036 – ident: ref14 doi: 10.1007/s00234-009-0520-0 – start-page: 533 volume-title: Percutaneous vertebroplasty with polymethylmethacrylate: technique, indications, and results year: 1998 ident: ref28 contributor: fullname: Deramond – ident: ref25 doi: 10.4184/asj.2015.9.3.483 – start-page: E1221 volume-title: A novel classification system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the Spine Oncology Study Group year: 2010 ident: ref22 contributor: fullname: Fisher – start-page: 137 volume-title: Preoperative percutaneous injection of methyl methacrylate and N-butyl cyanoacrylate in vertebral hemangiomas year: 1996 ident: ref10 contributor: fullname: Cotten – ident: ref23 doi: 10.1016/j.nec.2007.09.010 – ident: ref24 doi: 10.12659/ajcr.898562 – ident: ref9 doi: 10.1179/016164104773026516 – ident: ref20 doi: 10.1016/j.spinee.2017.11.003 – start-page: 656 volume-title: Spinal hemangiomas: results of surgical management for local recurrence and mortality in a multicenter study year: 2015 ident: ref31 contributor: fullname: Goldstein – ident: ref7 doi: 10.1097/00007632-200004150-00005 – ident: ref4 doi: 10.1016/j.nec.2007.10.005 – ident: ref5 doi: 10.4103/0973-1482.65248 – ident: ref16 doi: 10.1016/s0936-6555(05)80151-7 – ident: ref15 doi: 10.1097/brs.0000000000002973 – ident: ref18 doi: 10.3174/ajnr.a1010 – ident: ref13 doi: 10.1016/j.jocn.2006.06.004 – ident: ref12 doi: 10.1016/j.spinee.2013.07.450 – ident: ref29 doi: 10.4103/ajns.ajns_291_20 – ident: ref6 doi: 10.1016/j.ijrobp.2009.04.055 – start-page: 268 volume-title: Treatment of Enneking stage 3 aggressive vertebral hemangiomas with intralesional spondylectomy: report of 10 cases and review of the literature year: 2011 ident: ref11 contributor: fullname: Acosta – ident: ref19 doi: 10.7461/jcen.2013.15.4.320 – ident: ref17 doi: 10.3109/02841868509134375 – year: 2006 ident: ref1 contributor: fullname: Fletcher – start-page: 1036 volume-title: Primary bone tumors of the spine. Terminology and surgical staging year: 1997 ident: ref2 contributor: fullname: Boriani – ident: ref8 doi: 10.1177/145749691110000210 – start-page: 342 volume-title: One-stage total en bloc spondylectomy and reconstruction via a single posterior approach for thoracic vertebral symptomatic hemangioma associated with spinal cord dysfunction year: 2012 ident: ref21 contributor: fullname: Song |
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To analyze the surgical and neurological outcomes following surgical decompression in patients with aggressive vertebral... Study Design: This was a retrospective study.Purpose: To analyze the surgical and neurological outcomes following surgical decompression in patients with... STUDY DESIGNThis was a retrospective study. PURPOSETo analyze the surgical and neurological outcomes following surgical decompression in patients with... Study Design This was a retrospective study. Purpose To analyze the surgical and neurological outcomes following surgical decompression in patients with... |
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SubjectTerms | Clinical Study decompression embolization intralesional spondylectomy surgical treatment vertebral hemangioma vertebroplasty |
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Title | In Vertebral Hemangiomas with Neurological Deficit, Is a Less Extensive Approach Adequate |
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