Surgical Outcome of Vertebral Body Haemangiomas with Compressive Symptoms – An Institutional Experience

Abstract

Background: Vertebral body Haemangiomas (VH) are mostly asymptomatic, symptomatic one is difficult to manage, and which treatment modality is ideal is still controversial. We would like to present our institutional experience in managing aggressive VH by surgical decompression and the use of intraoperative alcohol ablation.

Objective: To know the role of intra-operative intra-lesional Ethanol injection, surgical decompression and stabilization of affected segments using Titanium Polyaxial screws and rods.

Methods: A prospective longitudinal study was done at IGIMS Patna in Symptomatic VH with compressive myelopathy.

Operative plan – Bilateral Transpedicular Intralesional absolute alcohol (<1% hydrated ethyl alcohol) injection, laminectomy decompression and stabilisation of the affected segment using polyaxial Titanium pedicle screws and rod.

Results: In this study, there were 19 patients which 10 were females and 9 were males presented with back pain, myelopathy, and sphincter dysfunction, having Pre-operative American Spinal Injury Association (ASIA) scores: A (9), B (5), C (3), D (2) and E (0). Mean surgical time was 120+30 minutes, mean blood loss was 250+50 cc and the mean amount of absolute alcohol used was 10+5 ml, post-op all patients improved on follow-up with a follow-up ASIA scores E (9), D (5), B (3) & C (2).

Conclusions: The use of intraoperative ethanol as an embolizing agent, laminectomy decompression and stabilization using screws and rods for symptomatic VH seems to be the ideal treatment modality in a resource-poor country like India.

Keywords – Vertebral Haemangioma, Compressive Myelopathy, Absolute alcohol