A 46-year-old woman presented to our emergency department with sudden onset of lower extremity weakness after physical activity. She referred only dorsal back pain before these symptoms. Neurologic examination revealed weakness 2 / 5 of lower limbs, hyperreflexia of deep tendon reflex of lower limbs, hypoesthesia under D7 level, and no sphincteric dysfunction. A computed tomography scan showed an accentuation of trabecular markings within the vertebral body and areas of lysis ( Figs. 1A F ). Contrast-enhanced magnetic resonance images show diffuse abnormal marrow signal throughout the T6 vertebral body with epidural components with spinal cord compression ( Fig. 1B H ).
Fig. 1.
Sagittal ( A ) and axial ( F ) computed tomography images demonstrating accentuation of trabecular markings within the vertebral body and areas of lysis involving the entire T6 vertebral body. Sagittal T1-weighted ( B ); sagittal ( C ) and axial ( G ) T2-weighted; sagittal ( D ), coronal ( E ), and axial ( H ) contrast-enhanced magnetic resonance images showing a T6 aggressive hemangioma with epidural extension and severe anterior cord compression.
Fig. 2.
Sagittal ( A ) and axial ( B-D ) postoperative computed tomography images demonstrating the posterior decompression and short pedicle screw fixation.
She underwent surgery on the same day through a mini-open decompression and percutaneous short posterior fixation ( Fig. 2 ). No complications occurred after surgery with full recovery of neurological symptoms. Radiotherapy was perfomed after 4 weeks with resolution of dorsal back pain.
Vertebral hemangiomas (VH) are benign and generally asymptomatic primary vascular tumors of bone. 1 2 Rarely, these lesions can cause symptoms due to cord compression as a result of bone expansion, erosion through cortex, fracture, or hematoma. 3 Despite our long-standing recognition of aggressive VH, there is still a controversy regarding the optimal treatment strategy, and numerous therapeutic options have been described: embolization, surgery, radiotherapy, vertebroplasty, or a combination of them. 4 5 6 7 8 9
Funding Statement
Funding None.
Footnotes
Conflict of Interest None declared.
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