tumors

Vertebral Angioma

Generality

The vertebral angioma is a benign tumor of the spine; to be precise, it is a hemangioma that originates from the rapid and uncontrolled proliferation of an epithelial cell of a blood vessel, intended for spraying a vertebra of the rachis.

Image from Radiopedia.com - See other Vertebral Angioma Photos

From yet unknown causes, vertebral angioma is only rarely a symptomatic condition; specifically, in such circumstances, the typical symptoms are: back pain, muscle weakness, numbness in the lower limbs, paralysis of different body areas, loss of control of anal and bladder sphincters and deformation of the spine.

An accurate diagnosis of vertebral angioma involves the execution of an X-ray and an MRI of the spine, as well as an angiography.

The planning and implementation of a therapy against vertebral angioma takes place only when the condition is symptomatic.

Short review of what a hemangioma is

A hemangioma is a particular benign tumor, belonging to the category of angiomas, which originates from the abnormal proliferation of a typical endothelial cell of the inner wall of blood vessels.

Consisting of a dense agglomeration of capillaries and slightly larger blood vessels, a hemangioma can:

  • Appear as a smooth patch, a raised papule or a nodule of a certain thickness;
  • Be red or purple;
  • Reside on the skin (cutaneous localization), in the dermis, on the mucous membranes or on the internal organs (brain, heart, spleen, liver, respiratory tract, bones etc.).

According to the most recent classifications, there are three types of hemangioma: the capillary hemangioma, the cavernous hemangioma and the pyogenic granuloma (for their characteristics, see the table below).

Table. Subtypes of hemangioma and their main characteristics.
Subtype Location Appearance
Capillary hemangioma (ex: ruby ​​angioma and "angioma of the newborn")
  • Skin
  • Smooth patch or papule detected
  • Red or purple color
Cavernous hemangioma or cavernoma (eg, liver angioma)
  • Derma
  • Internal organs
  • Nodule
  • Red or purple color
Pyogenic granuloma
  • Skin
  • mucous
  • Nodule
  • Red

What is vertebral angioma?

The vertebral angioma or spinal angioma is a particular cavernous hemangioma that grows on the vertebral column, starting from an endothelial cell of a blood vessel delegated to spray a vertebra .

What is the most common venue?

Any tract of the spine may be the site of formation of a vertebral angioma. However, statistics show that there are regions of the spine (synonymous with the spine) that are much more affected than others; among these regions particularly susceptible to the formation of vertebral angiomas, include the thoracic tract and the lumbar tract .

Epidemiology

According to some studies, the vertebral angioma would affect at least 10% of the population; if this numerical data were true, vertebral angiomas would represent a fairly common phenomenon.

According to some experts in the field, vertebral angiomas would more frequently affect women than men (2: 1 ratio); according to the opinion of other researchers, instead, the above would be false, while a greater predisposition by women to develop symptomatic vertebral angiomas would be more true.

Statistics in hand, vertebral angioma is a formation typical of adulthood, most likely to be found in people over thirty.

Causes

Despite numerous studies on the subject, the causes of vertebral angioma are unknown.

Are there hypotheses concerning the possible causes?

The most accredited theories concerning the causes of vertebral angiomas believe that some genetic factors, transmitted by inheritance, may play a decisive role in the development of the latter.

Formation of a vertebral angioma: how does it happen?

The vertebral angioma is the result of the rapid and uncontrolled proliferation of an endothelial cell of a blood vessel delegated to spray a vertebra of the rachis.

This proliferation involves the neoformation of capillaries and larger blood vessels, which, massed together, constitute what is then called vertebral angioma.

At the conclusion of this abnormal proliferative process, the vertebral angioma has a nodular appearance and takes place close to the vertebra supplied by the blood vessel, from which the tumor process began

Symptoms and complications

Vertebral angioma is a generally asymptomatic presence; in fact, cases of vertebral angiomas associated with symptoms are a real rarity.

In percentage terms, it appears that only 5% (*) of patients with a vertebral angioma experience symptoms related to the presence of the latter.

* NB: according to some sources, the percentage of symptomatic vertebral angiomas would be equivalent to 20% of all clinical cases diagnosed.

Even if this were true, symptomatic vertebral angioma would still be a very uncommon circumstance.

What are the symptoms of vertebral angioma and what do they depend on?

When it is symptomatic, the vertebral angioma causes:

  • Pain where the benign tumor is located. It is the result of the compression that the vertebral angioma exerts on the spinal cord, contained within the vertebra on which the benign tumor in question is located.

    If the vertebral angioma is particularly large or becomes larger over time, the painful sensation can spread elsewhere and affect the upper limbs (arms and hands in particular) and lower limbs (especially the hips, legs and feet).

  • Sense of muscle weakness in the lower limbs . It is a possible consequence of the compression that the vertebral angioma can exert on the sensory nerve structures (sensory spinal nerves), located near the vertebra on which the benign tumor is located.
  • Insensitivity and sense of numbness along the lower limbs ; paralysis of varying degrees and dependent on different body areas. Other possible consequences of nerve compression produced by the vertebral angioma damage the neighboring sensory spinal nerves.
  • Loss of control of anal and bladder sphincters . It is a consequence of the compression that a large vertebral angioma can cause to the spinal cord.
  • Spinal deformation . It depends on the infiltration of the vertebral angioma at the level of the host vertebra. This phenomenon, in fact, involves a modification of the vertebra involved, which results in the collapse (or failure) of the latter and in an alteration of the overall structure of the spine.

Factors that make a vertebral angioma a symptomatic presence:

  • High size of the tumor mass
  • Spinal cord compression
  • Compression of sensory spinal nerves
  • Benign tumor infiltration on the vertebra that houses it and consequent vertebral collapse

When should I go to the doctor?

In general, it is always a valid reason to immediately contact your doctor and arrange a check-up, the sudden appearance of symptoms, such as back pain, a feeling of muscle weakness and numbness in the lower limbs, loss of control of the anal sphincters and bladders, loss of sensitivity in the lower limbs and paralysis of some parts of the body.

For people with an asymptomatic vertebral angioma, the recommendation is to consult a doctor experienced in pathologies of the spine when the benign tumor begins to show itself with the aforementioned symptoms.

Complications

The complications of a vertebral angioma obviously concern only the symptomatic cases and consist in a worsening of the symptomatology, such as to seriously compromise the quality of life of the patients.

As regards a possible malignant evolution of the vertebral angioma (ie the transformation of the vertebral angioma into a malignant tumor of the spine), this dreaded phenomenon is very rare, if not impossible.

Diagnosis

In general, the identification of an asymptomatic vertebral angioma is random, the result of diagnostic investigations carried out for other reasons. Moreover, the absence of symptoms makes the benign tumor in question an unsuspected presence.

How to diagnose symptomatic vertebral angioma

Canonically, the diagnosis of symptomatic vertebral angioma is based on: an accurate physical examination, an in-depth history, radiograph of the vertebral column, nuclear magnetic resonance of the spine and angiography (or, alternatively angioTAC ).

OBJECTIVE AND ANAMNESIS EXAMINATION

Physical examination and anamnesis consist essentially in the observation and critical study of the symptoms manifested by the patient.

They are always the first step in the examination and testing process leading to the diagnosis of vertebral angioma.

RADIOGRAPHY AND NUCLEAR MAGNETIC RESONANCE OF THE VERTEBRAL COLUMN

Although with different technologies and physical principles, radiography and nuclear magnetic resonance of the spine provide detailed images of the entire spine and, in the presence of vertebral angioma, allow the identification of the precise site of the latter.

Nuclear magnetic resonance is a more detailed instrumental test than radiography; from the observation of his images, in fact, doctors are able to see if the vertebral angioma has formed behind some spinal nerve and is causing its compression.

ANGIOGRAPHY

By injecting a visible X-ray contrast agent into a blood vessel, angiography allows doctors to study different features of the vertebral angioma, including size, density of blood vessels forming the tumor mass, precise site, etc.

Its alternative - the so-called angioTAC - works slightly differently, but has the same purpose.

Curiosity

An examination such as angiography is particularly important when the vertebral angioma requires surgical treatment, aimed at its removal.

Therapy

Vertebral angioma requires specific treatment only when it is symptomatic; therefore, in all the cases in which this benign tumor is devoid of an associated symptomatology, the doctors opt for not intervening (after all, if the vertebral angioma does not cause any kind of discomfort, it makes little sense to implement a therapy).

Symptomatic vertebral angioma therapy

Treatments for the treatment of symptomatic vertebral angiomas are varied; the use of one of these treatments, rather than another, depends on some specific characteristics of the benign tumor in question, including: size, location, density of constituent blood vessels, and type of symptoms in progress.

Going into the details of today's possible treatments for vertebral angioma, these include:

  • Radiotherapy . It consists in "bombarding" the benign tumor with a certain dose of ionizing radiation.

    Radiotherapy stops the growth of the vertebral angioma and favors its regression, but it cannot eliminate it completely.

    However, except for the aforementioned limit, it is a very precise treatment.

  • Vertebrectomy . It is the delicate and radical surgical operation of removing, from a vertebra, the so-called vertebral body (NB: the vertebral body is one of the main components of a vertebra), followed by the grafting (or transplantation) of a special replacement element (in order to to guarantee the same functions offered by the removed body).

    The vertebrectomy performed due to a vertebral angioma has as its object the vertebra on which the aforementioned tumor resides, in order to eliminate the latter definitively and resolve the entire symptomatology.

  • Laminectomy . It is the delicate surgical operation on the vertebral column, which involves the removal of the so-called vertebral lamina (NB: it is a characteristic element of the vertebrae), in order to reduce the symptoms related to spinal cord compression and sensory spinal nerves.

    The laminectomy is usually a symptomatic treatment, but it can also be a causal therapy, when the vertebral angioma resides on the vertebral lamina object of removal.

  • Kyphoplasty and vertebroplasty . These two particular procedures find employment when the vertebral angioma has caused the collapse of the vertebra on which it was formed. In fact, kyphoplasty and vertebroplasty make it possible to remedy vertebral collapse and recover the normal anatomy of the spine, by injecting a cementing or silicone substance into the vertebra of interest, both having a supporting function.

    For the avoidance of doubt, it should be pointed out that the realization of a kyphoplasty or a vertebroplasty does not allow to eliminate the vertebral angioma, but only to improve the symptomatological framework.

  • Injection of ethanol into the tumor blood vessels . Promotes blood clotting circulating within the blood vessels that make up the vertebral angioma.

    As a rule, it is a preparatory treatment for one of the aforementioned surgical techniques, in order to reduce the risk of bleeding.

  • Embolization . It consists in the injection into the vertebral angioma of a special autocoagulant resin, which, solidifying, prevents the blood from flowing into the vessels constituting the benign tumor in question.

    Embolization is one of those preparatory treatments for surgical removal of the vertebral angioma, carried out with the aim of reducing the risk of bleeding.

Prognosis

For a variety of reasons, including lack of symptoms, improbable malignant tumor transformation and good treatment efficacy, the prognosis in case of vertebral angioma tends to be positive.