• Lei Dang, Chen Liu, Shao Min Yang, Liang Jiang, Zhong Jun Liu, Xiao Guang Liu, Hui Shu Yuan, Feng Wei, and Miao Yu.
• Orthopaedic Department, Peking University Third Hospital, No 49 North Garden Road, HaiDian District, Beijing, China. danglei_2000@yahoo.com
• Eur Spine J. 2012 Oct 1;21(10):1994-9.

PurposeVertebral hemangioma (VH) is virtually vascular malformation, which is usually asymptomatic. Only 3.7 % of VH may become active and symptomatic, and 1 % may invade the spinal canal and/or paravertebral space. Treatment protocols for active or aggressive VHs are still in controversy. Reported treatments include radiotherapy, vertebroplasty, direct alcohol injection, embolization, surgery and a combination of these modalities.MethodsA 41-year-old lady was presented with 18 month history of intermittent back pain. CT revealed T5 osteolytic lesion with epidural and paravertebral extension. The first CT guided biopsy yielded little information.ResultsHistopathological diagnosis of the second biopsy was VH. Vertebroplasty, posterior decompression and fixation were performed followed by postoperative radiotherapy. Her symptoms were resolved immediately after the operation. At 12 months follow-up, no recurrence was detected by CT with contrast enhancement.ConclusionSurgical decompression, vertebroplasty and fixation are safe and effective for aggressive VH. More attention is needed in determining the algorithm for the diagnosis and treatment of aggressive VH.

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