Stepwise approach for vertebral hemangioma in children: case-reports and treatment algorithm proposal

Area of Science:

• Pediatric Orthopedics
• Interventional Radiology
• Neurosurgery

Background:

• Vertebral hemangioma (VH) is an uncommon cause of pediatric low back pain.
• VHs are often incidental findings, but symptomatic cases require management.

Observation:

• A novel treatment algorithm for pediatric VH is presented.
• The algorithm stratifies treatment based on tumor extension and spinal cord compression.
• Two aggressive VH cases (Stages 3 and 4) were successfully managed using this protocol.

Findings:

• A young girl with Stage 3 VH received posterior instrumentation and medical therapy.
• An 8-year-old boy with Stage 4 VH underwent combined anterior/posterior surgery after embolization.
• Multidisciplinary team approach was crucial for managing aggressive cases.

Implications:

• This stepwise approach may guide the treatment of pediatric vertebral hemangioma.
• Addresses the lack of international guidelines for VH management in children.
• Highlights the importance of tailored treatment based on clinical and radiological features.