About Vertebral Hemangioma
A hemangioma is an abnormal, but benign blood vessel tumor that commonly occurs in the spine. Our research has found these to be present in up to 40% of patients who undergo an MRI of the lumbar spine. These are usually about the size of a quarter or smaller. The vast majority of these lesions do not cause symptoms, so if you have one that actually does hurt (painful vertebral hemangioma), then the diagnosis is usually delayed.
Causes of Painful Vertebral Hemangioma
Although we aren’t sure exactly what causes hemangiomata*, there are a few things that cause them to become painful. Most patients have either had recent trauma, such as a car wreck or fall, or they have increased their physical activity—we had a recent patient who had started working out more and one who went from a desk job to a warehouse stocker.
Whatever the cause, it usually means that there is increased axial loading—that is, more force is going down the spine. This causes microfractures in the hemangioma at a rate faster than the body can heal them. A hemangioma in this case causes pain because replaces normal bone and puts more stress on the rest of the bone (kind of like knocking out a supporting wall when you are remodeling).
Diagnosis and Treatment
Overall, even among spine specialists, hemangioma is an underdiagnosed cause of pain. Fortunately for us, if a proper physical exam is performed in the area and an MRI is obtained, a symptomatic (painful) hemangioma is easy for us to diagnose.
Better yet, if a patient has a hemangioma that is causing pain, this responds roughly 95% of the time to kyphoplasty—a 15 minute outpatient procedure.