According to statistics, the leading causes of death in our country, in addition to accidents and cardiovascular pathology, belong to oncological diseases. 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 formation is detected. In such cases, the prognosis is considered more favorable when the treatment of the pathology is possible, and its result leads to the complete healing of the patient. Spinal hemangioma is one of these cases.
What is this?
In general terms, such a disease can appear both on the skin and affect various internal organs and systems, often remaining hidden from the eyes of its carrier all its life or being discovered by chance during examination of any disorder, including pathological changes in the skeletal system. If we talk specifically about the diagnosis of "hemangiomaspine" - what is it, then modern medicine defines it in the category of benign neoplasms, which are a conglomerate of vascular bundles, sometimes displacing bone tissue. In this regard, this pathology is also called "vertebral angioma" or "arteriovenous malformation".
Let's find out, the very name "hemangioma" (of the spine) - 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 grows slowly and does not metastasize. The primary characteristic localization is the cavity of the vertebral body, as well as the cartilaginous substance between them. However, there are other, more rare and unusual locations in the bones. In the very substance of the spinal cord, dividing cells of these pathological vessels are also often detected, confirming the local origin of the growing formation.
Among all tumors of the skeletal system, hemangioma of the body of the spine occupies a tenth of the pathological formations presented here, proceeding both with violent clinical symptoms and being an accidental finding during pathomorphological examination.
Etiology of disease
About such a disease 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 mechanisms of development of such a benign vascular disease.tumors.
Unfortunately, even at the beginning of the 21st century, medical science does not give precise definitions of the etiology of this neoplasm. It is accepted to allocate predisposing factors of the disease. The main one is a family predisposition, which determines the appearance of congenital disorders in the structure of the vessel wall at the level of the vertebra through the presence of a gene defect and mutations.
In addition, factors such as local tissue hypoxia and increased levels of the female hormone estrogen, which is confirmed by statistical data, make their own contribution. This pathology is found in the older female population almost 5 times more often than in men.
Pathogenetic features
After birth, an already changed vertebra will be exposed to various mechanical and physical effects throughout life, which 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 vacant place after the process of recanalization of blood fibrin clots. So, slowly but surely, the pathological vascular conglomerate grows.
Characteristic localizations of lesions of the vertebrae
Hemangioma of the thoracic spine - the most commonoccurring level of lesion, especially within his sixth vertebra. This localization occurs in 85 percent of observations.
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 from 2 to 5 vertebral bodies.
Hemangioma of the lumbar spine, especially its upper levels, the second most common tumor localization.
Given the characteristic places of neoplasms, it is not difficult to guess what provokes the main symptoms of the disease. It manifests itself against the background of local negative dynamics in the form of a change in the parameters of the body of a pathologically formed vertebra, its height with the development of collapse and possible compression of the adjacent nerve trunks by such a formation 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 for spinal hemangiomas
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 cases where 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 a hemangioma of a specific localization asaggressive, especially with its severity and constancy. Such cases are up to 4%. The pain in this case is caused by compression of the nerve endings and spinal cord due to the blood filling of the tumor vessels during active movements, tilts, changes in the position of the body 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 pain when turning the neck or bending the body, discomfort at the site of the lesion, including when performing various physical activities. Night burning pains in the area of tumor localization are specific.
Normal loading becomes dangerous and can lead to a compression fracture if more than half of the vertebral body is affected by the pathological process. If a violation of the integrity of the vertebra is already observed, then compression of the substance of the spinal cord can be manifested by serious changes, up to urination disorders, or motor disorders such as paralysis.
Diagnostic measures to detect pathology
Identification 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 tomography 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. Exceptdetection and diagnosis of hemangioma, additional examination methods are carried out in order to monitor and control a benign neoplasm. Tracking the growth rate and taking into account the pathomorphology of the tumor structure itself, dynamic observation solves the problem of how to treat spinal hemangioma.
Management of patients with spinal hemangioma
With constant monitoring of the tumor, the expectant management of the patient with a stable and slowly progressing development is taken as the basis. Only in case of aggressive growth, medical manipulations are carried out.
Depending on the location and size of the hemangioma, a specific method of therapy is selected.
Sclerotherapy is the main and effective method of exposure
To stop growth from the inside, a neoplasm is filled with a special substance through the skin with a special needle, resembling bone cement in properties. Such a material is polymethyl methacrylate, after the introduction of which the hemangioma vessels become empty, 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 kind of sclerotherapy, a foaming agent is used, which is delivered directly to the tumor with the help of 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 itsreverse development and sclerosis. This method is used when there is no danger of a compression fracture of the vertebral body, as well as when there is a likelihood of bleeding from hemangiomatous vessels.
The surgical method is used when it becomes necessary to decompress the substance of the spinal cord and its roots with the destruction of bone structures and compression of nearby nerve elements. A resection of the formation itself is also performed.
Dangers and precautions for managing a patient with hemangioma
The previously known radiation method of influencing hemangioma is currently used quite rarely due to the availability of more effective and safer methods.
It must be remembered that if 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 to minimize exacerbations and provocations of the growth of the pathological focus should be avoided.
Unfortunately, in modern conditions of life, including the environment, food, water and air, few can boast of excellent he alth. Although hemangioma refers to tumor processes, it 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.
