Aggressive Vertebral Hemangioma and Spinal Cord Compression: A Particular Direct Access Case of Low Back Pain to Be Managed—A Case Report

Abstract

Hemangiomas are the most common benign tumours affecting the spine, with an incidence of 10–12% of the general population. Although most hemangiomas are asymptomatic, there are aggressive forms which can develop symptoms, leading patients to show signs of disability. This case report aims to highlight the importance of red flags screening, and to report the physiotherapist’s clinical reasoning that led him to refer his patient to other healthcare professionals. This case also illustrated the pre- and post-surgical treatment of a specific low back pain case in a patient affected by aggressive vertebral hemangioma and spinal cord compression. The patient is a 52-year-old man, who reported intense pain in his sacral region about three months prior, which worsened while in sitting position. The physiotherapist proceeded with a complete medical history investigation and clinical examination. After an impaired neurological examination, the patient was referred to another health professional, who diagnosed multiple vertebral hemangiomas in the patient’s lumbosacral tract. The therapeutic intervention included the patient’s post-surgical rehabilitation following a vascular embolization. This case report shows the importance of proper patient screening. Indeed, during patients’ assessment, it is paramount to recognize red flags and to investigate them appropriately. An early referral of patients with conditions that require the support and expertise of other professionals can lead to a timely diagnosis and avoid costly and unnecessary rehabilitation procedures. In this case, the interdisciplinary collaboration between physiotherapist and neurosurgeon was crucial in guiding the patient towards recovery.

Successful surgical treatment of a sacral hemangioma causing cauda equina dysfunction: a case description

“…Surgery is a relatively effective treatment for invasive sacral hemangioma, but early diagnosis and treatment and postoperative rehabilitation are critical steps for comprehensive treatment, as they can ensure avoiding excessive damage to neurological function and facilitate the recovery of neurological function after surgery. In 2022, Brindisino et al reported a case of invasive VH with spinal cord compression, which highlighted the importance of rapid clinical diagnosis and treatment as well as postoperative rehabilitation planning with rehabilitation physicians for postoperative neurological recovery ( 14 ).…”

Rapid Recuperation After Surgical Intervention and Rehabilitation in a Patient With Spinal Hemangioma: A Case Report

“…Myofascial therapy, muscle-strengthening exercises, and mobilization treatments are gradually introduced as the rehabilitation program progresses. The patient's physical strength and mobility are being gradually rebuilt through this step-by-step process [19]. In another study, carried out by Chu and Leung, the patient underwent conservative treatment, including robotic traction therapy and thoracic spinal adjustments, to address intervertebral limitations while maintaining the hemangioma site pristine [20].…”

Sequential correction using satellite rod for the treatment of severe rigid spinal deformity: a retrospective study of 19 cases

“…Back pain is sometimes a permeance of scoliosis, which leads to the neglect of the diagnosis of scoliosis. Early differential diagnosis to exclude other severe problems is particularly important [ 15 – 17 ]. Poor prognosis is more often appeared in untreated patients with severe rigid spinal deformity, with approximately 5% of them developing chronic respiratory failure as adults [ 18 ].…”