Outcomes Following Different Treatment Modalities of Aggressive Vertebral Hemangiomas: A Systematic Review and...

Area of Science:

• Spine surgery
• Oncology
• Radiology

Background:

• Vertebral hemangiomas (VHs) are common primary spine tumors (10-12% prevalence).
• Aggressive VHs (AVHs) comprise ~1% and can cause bone erosion and symptoms.
• Treatment focuses on controlling growth and alleviating symptoms.

Purpose of the Study:

• To evaluate the effectiveness of various treatment modalities for aggressive vertebral hemangiomas (AVHs).
• To assess symptom resolution and recurrence control in AVH patients.

Main Methods:

• Systematic review adhering to PRISMA 2020 guidelines.
• Searched Medline and Scopus (2000-2023) for studies on primary AVH (Enneking stage 3) in adults.
• Extracted data on demographics, treatment, outcomes, and recurrence from 16 studies (149 patients).

Main Results:

• Symptom resolution was 43.4%, with Frankel score improvement in 68.4%.
• Embolization, open surgery, and complete resection correlated with symptom improvement.
• Kyphoplasty/vertebroplasty showed high symptom resolution (82.5%); no independent predictors for recurrence were identified.

Conclusions:

• Embolization, ablation, vertebroplasty, and kyphoplasty are viable for AVHs without cord compression.
• Open surgery is considered for AVHs with cord compression.
• Radiation therapy is an option for persistent pain or locally advanced tumors.