Intraoperative vertebroplasty during surgical decompression and instrumentation for aggressive vertebral hemangiomas: a retrospective study of 39 patients and review of the literature

Publication date: Available online 14 November 2017
Source:The Spine Journal
Author(s): Ben Wang, Song Bo Han, Liang Jiang, Xiao Guang Liu, Shao Min Yang, Na Meng, Feng Wei, Zhong Jun Liu
Background ContextAggressive (Enneking Stage 3, S3) vertebral hemangiomas (VHs) are rare, which might require surgery. However, the choice of surgery for S3 VHs remains controversial because of the rarity of these lesions.PurposeWe reported our experience of treating S3 VHs, and evaluated the effectiveness and safety of intraoperative vertebroplasty during decompression surgery for S3 VHs.Study DesignThis is a retrospective study.Patient SampleThirty-nine patients with a definitive pathological diagnosis of aggressive VHs who underwent primary decompression surgery in our department were included in this study.Outcome MeasuresBasic data such as surgical procedure, surgical duration, estimated blood loss during surgery, pathology were collected. The modified Frankel grade was used to evaluate neurological function. Enneking staging was based on radiological findings.MethodsWe retrospectively examined aggressive VHs with neurological deficits. Surgery was indicated if the neurological deficit was severe or developed quickly or if radiotherapy was ineffective. Decompression surgery was performed. Intraoperative vertebroplasty during posterior decompression has been used since 2009. If contrast-enhanced CT revealed a residual lesion, we recommended adjuvant radiotherapy with 40–50 Gy to prevent recurrence. Patients' basic and surgical information was collected. The minimum follow-up duration was 18 months. This study was partially funded by XXXXXX (Blinded).ResultsAverage age of the 39 patients with S3 VHs who underwent primary decompression surgery was 46.2 (range, 10–69) years. All patients had neurological deficits caused by aggressive VHs. Aggressive VH lesions were located in the cervical, thoracic, and lumbar spine in two, 32, and five patients, respectively. The decompression-alone group had 17 patients and the decompression plus intraoperative vertebroplasty groups had 22. There were no statistically significant intergroup differences in preoperative information (P > 0.05). The average estimated blood losses were 1764.7 mL (range, 500–4000 mL) and 1068.2 mL (range, 300–3000 mL) in the decompression-alone and decompression plus vertebroplasty group, respectively (P = 0.017). One patient who underwent primary decompression alone without adjuvant radiotherapy experienced recurrence after the first decompression. The average follow-up was 50.2 (range, 18–134) months, and no cases of recurrence were observed at the last follow-up.ConclusionsOur results suggest that posterior decompression effectively provides symptom relief in patients with aggressive (S3) VHs with severe spinal cord compression. Intraoperative vertebroplasty is a safe and effective method for minimizing blood loss during surgery, while adjuvant radiotherapy and/or vertebroplasty help in minimizing recurrence after decompression.



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