According to statistics, the leading positions among the main causes of death in our country, in addition to accidents and cardiovascular pathology, belong to cancer. And for the most part, especially if the tumor is malignant, such a diagnosis sounds like a sentence. The situation is somewhat different when a benign mass is detected. In such cases, the prognosis is considered more favorable when treatment of the pathology is possible, and its result leads to the complete healing of the patient. Such cases include hemangioma of the spine.
What it is?
In general terms, such a disease can appear on the skin, as well as affect various internal organs and systems, often remaining hidden for the whole life from the eyes of its carrier or being discovered by chance when examining a violation, including pathological changes in the bone system. Speaking specifically about the diagnosis of “spinal hemangioma” - what it is, then modern medicine defines it as a benign neoplasm, which is a conglomerate of vascular bundles, sometimes crowding out bone tissue. In this regard, this pathology is also called "vertebral angioma" or "arteriovenous malformation."
Let's find out the name "hemangioma" (spine) itself - what is it? The term comes from the Greek words haima - blood, angeon - vessel, "oma" - the ending characteristic of all pathological tissue growths.
The tumor itself is slowly growing and does not form metastasis. The primary characteristic localization is the cavity of the vertebral body, as well as the cartilage between them. However, there are other, more rare and unusual locations in the bones. Fissile cells of these pathological vessels are also often detected in the substance of the spinal cord , confirming the local origin of the growing formation.
Among all tumors of the skeletal system, the hemangioma of the spine body occupies a tenth of the pathological formations presented here, proceeding with violent clinical symptoms, and being an accidental finding during pathomorphological examination.
Etiology of the disease
About a disease such as hemangioma of the spine - what it is, where it is located and how it manifests itself - the reader has already had primary superficial ideas. Now is the time to start studying the causes and development mechanisms of such a benign vascular tumor.
Unfortunately, even at the beginning of the 21st century, medical science does not give exact definitions of the etiology of this neoplasm. It is customary to identify predisposing factors of the disease. The main one is a family predisposition, which determines by the presence of a defect in genes and mutations the appearance of congenital disorders of the structure of the vessel wall at the level of the vertebra.
In addition, factors such as local tissue hypoxia and an increased level of the female hormone estrogen make a certain contribution, which is confirmed by statistical data. This pathology is found in the older female population almost 5 times more often than in men.
Pathogenetic features
The already changed vertebra after birth throughout life will have various mechanical and physical effects that can contribute to the appearance of permanent microtraumas and hemorrhages from pathologically thin and fragile vessels. To stop hemorrhages, the body activates coagulation reactions, including the formation of a massive amount of blood clots at the local level. At the same time, osteoclast cells are activated, destroying the bone beams of the vertebral bodies and promoting the growth of newly formed vessels in the vacated area after the process of recanalization of blood fibrin clots. So, slowly but surely, there is an increase in pathological vascular conglomerate.
Characteristic localization of vertebral lesions
Hemangioma of the thoracic spine is the most common level of damage, especially within its sixth vertebra. This localization occurs in 85 percent of cases.
In 2% of cases, lesions of the cervical or sacral vertebrae are likely . There are also clinical observations of the development of multiple hemangiomatosis, affecting 2 to 5 vertebral bodies.
Hemangioma of the lumbar spine, especially its upper levels, the second most frequent tumor location.
Given the characteristic sites of neoplasms, it is not difficult to guess what causes the main symptoms of the disease. It manifests itself against the background of local negative dynamics in the form of changes in the parameters of the body of a pathologically formed vertebra, its height with the development of collapse and possible compression of the nerve trunks passing by, such as spinal hemangioma. The size of the tumor, especially if it occupies the entire vertebral cavity, directly affects the clinic and the degree of manifestation of the pain syndrome.
Clinic of hemangiomas of the spinal column
As mentioned above, the symptoms of the disease are most often erased. And the patient seeks medical help for back pain caused by a completely different pathology. However, hemangioma can also give a clinic of pain in those cases when its size exceeds 1 cm, which is an alarming symptom - a kind of harbinger of a future compression fracture of the body of the affected vertebra. Persistent pain syndrome characterizes the growth of hemangiomas of a particular localization as aggressive, especially with its severity and constancy. Such cases make up 4%. The pain in this case is due to compression of the nerve endings and the cerebrospinal substance due to the blood vessels of the tumor during active movements, inclinations, changes in the position of the trunk in space, as well as thrombosis, followed by tension of the ligamentous apparatus of the spinal column.
For example, hemangioma of the cervical spine can be manifested by local pains when turning in the neck or flexing the body, unpleasant sensations at the site of the lesion, including when performing various physical activities. Specific are burning night pains in the area of tumor localization.
A normal load becomes dangerous and can lead to a compression fracture in case of damage to the pathological process of more than half of the vertebral body. If a violation of the integrity of the vertebra is already observed, then compression of the substance of the spinal cord can manifest itself as a serious change, up to an urination disorder, or as a motor disorder like paralysis.
Diagnostic measures for the detection of pathology
The detection of hemangioma is difficult due to the peculiarities of its long and slow growth, as well as the asymptomatic course in most cases.
The main modern diagnostic methods are computed and magnetic resonance imaging, X-ray examination of the spine, as well as angiography of a pathological formation with the introduction of contrast and the production of a series of images. In addition to the detection and diagnosis of hemangiomas, additional examination methods are carried out to monitor and control a benign neoplasm. Tracking the growth rate and taking into account the pathomorphology of the tumor structure itself, due to dynamic observation, the question of how to treat spinal hemangioma is resolved.
Management tactics for patients with spinal hemangioma
With constant monitoring of the tumor, the expectant management tactics of the patient is taken as a basis with its stable and slowly progressing development. Only in case of aggressive growth are medical manipulations performed.
Depending on the location and size of the hemangioma, a specific method of therapy is chosen.
Sclerotherapy - the main and effective method of exposure
To stop the growth, the neoplasm from the inside is filled with a special needle through the skin with a special substance that resembles bone cement in properties. Such material is polymethylmethacrylate, after the introduction of which the hemangioma vessels are launched, and the vertebral cavity is strengthened. Therefore, this method of treatment is called percutaneous puncture vertebroplasty. It is performed under general or local anesthesia.
As a type of sclerotherapy, the introduction of a foaming agent is used, which is delivered directly to the tumor using a catheter. It acts as an embolus, clogging the supply vessels and stopping the delivery of nutrients to the focus of pathological growth, gradually leading to its reverse development and sclerosis. This method is used in the absence of the danger of a compression fracture of the vertebral body, as well as with the likelihood of bleeding from hemangiomatous vessels.
The surgical method is resorted to when there is a need for decompression of the substance of the spinal cord and its roots with the onset of destruction of bone structures and compression of adjacent nerve elements. A resection of the education itself is also carried out.
Dangers and warnings on the management of hemangioma patients
The previously known radiation method for treating hemangioma is currently rarely used due to the availability of more effective and safe methods.
It must be remembered that when such a pathological formation is found in a person, such effects on the body as warming up, massage, any manual and physiotherapeutic procedures, as well as traditional medicine should be avoided to minimize exacerbations and growth provocations of the pathological focus.
Unfortunately, in modern living conditions, including the environment, food, water and air, few can boast of excellent health. Hemangioma, although it refers to tumor processes, but still has a benign course in most cases. And with its dynamic observation and the absence of aggressive growth, the quality of life does not suffer.