Surgical Outcomes for Vertebral Body Hemangiomas With Compressive Symptoms: An Institutional Experience

Background Vertebral hemangiomas (VHs) are benign vascular tumors commonly found within the vertebral bodies of the spine. While most VHs remain asymptomatic and are often discovered incidentally during imaging studies, a subset can become symptomatic, leading to clinical challenges. The optimal treatment approach for symptomatic VHs remains a topic of debate. At our institution, we have managed aggressive VHs through a combination of surgical decompression and intraoperative alcohol ablation. The objective of this research is to evaluate the effectiveness of a combined treatment approach involving intralesional ethanol injection, surgical decompression, and stabilization using titanium polyaxial screws and rods in managing symptomatic VHs with compressive symptoms. Methodology A prospective longitudinal study was conducted at the Indira Gandhi Institute of Medical Science, Patna, in patients with symptomatic VHs associated with compressive myelopathy. The operative plan involved bilateral transpedicular intralesional injection of absolute alcohol (<1% hydrated ethyl alcohol), followed by laminectomy decompression and stabilization of the affected segment using polyaxial titanium pedicle screws and rods. Results A total of 19 patients were included in the study, consisting of 10 females and nine males, all presenting with back pain, myelopathy, and sphincter dysfunction. Preoperative American Spinal Injury Association (ASIA) scores were as follows: A (9), B (5), C (3), D (2), and E (0). The average duration of the surgery was 120 minutes, with a standard deviation of 30 minutes. The average blood loss recorded was 250 cc, with a variability of 50 cc, and the typical volume of absolute alcohol utilized was 6 ml, with a standard deviation of 5 ml. Postoperatively, all patients showed improvement, with follow-up ASIA scores of E (9), D (5), B (3), and C (2). Conclusions The use of intraoperative ethanol as an embolizing agent, laminectomy decompression, and stabilization using screws and rods for symptomatic VHs seems to be ideal treatment modality in resource-poor countries like India.