Percutaneous vertebroplasty in painful refractory vertebral hemangiomas

Abstract

Background:Painful vertebral hemangiomas are often inadequately managed medically. We evaluated the outcome of percutaneous vertebroplasty (PVP) in the treatment of painful vertebral hemangiomas refractory to medical management.Materials and Methods:14 patients (four thoracic and ten lumbar vertebra) with painful vertebral hemangiomas presenting with severe back pain for more than 6 months not responding to medical therapy were treated by vertebroplasty. Cross sectional imaging of the spine with magnetic resonance was done. Blood investigations were done to exclude coagulopathy excluded. PVP was performed under local anesthesia.Results:The pain intensity numeric rating scale (PI-NRS-11) of these patients was in the range of 7-10 (Severe Pain). After vertebroplasty 8 patients were completely free of pain (PI NRS Score 0) while 6 were significantly relieved (PI-NRS Score 1-3). No complications were observed. Two patients with associated radicular pain had good pain relief following PVP. No recurrence was found during 36 months of postoperative followup.Conclusion:PVP is a safe and effective procedure in patients with painful vertebral hemangiomas refractory to medical management.

Response to the Letter to the Editor Concerning “Management of Aggressive Vertebral Haemangioma and Assessment of Differentiating Pointers Between Aggressive Vertebral Haemangioma and Metastases-A Systematic Review” by Subramaniam et al.

“…CONCERN 1 : We agree the fact that Pain Intensity – Numeric Rating Scale (PI-NRS) used by Narayana et al 1 is different when compared to the Visual Analog Scale (VAS). PI-NRS and VAS are the 2 most widely used pain assessment tools and the popularity of both scales sometimes causes VAS to be mistaken as NRS and vice versa, however, there remain high correlations between both tools as stated.…”

Extrapedicular Infiltration Anesthesia as an Improved Method of Local Anesthesia for Unipedicular Percutaneous Vertebroplasty or Percutaneous Kyphoplasty

“…Since the first reports of percutaneous vertebroplasty procedures in 1987, percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) have been widely used to treat osteoporotic vertebral compression fractures, myeloma, and vertebral metastases. Advantages of the procedure include minimal surgical invasiveness, good pain relief, and rapid recovery [ 1 – 3 ].…”

Management of Aggressive Vertebral Haemangioma and Assessment of Differentiating Pointers Between Aggressive Vertebral Haemangioma and Metastases – A Systematic Review

“…External beam radiation with close surveillance has been modality of intervention for those patients presenting with back pain and slowly progressive or mild neurological deficit 15 (20.3%). Invasive posterior or anterior surgery has been the mainstay of treatment for those patients presenting with rapidly progressive neurological deficit or with severe myelopathic symptoms [16][17][18][19][20][21] (59.7%).…”

“…Ben wang et al 15 Wei hong Xu et al 20 Cloran et al 3 Nair et al 16 Singh et al 19 Prabhuraj et al 18 Narayana et al 17 Zhang et al 21 (14.1%). CT guided alcohol ablation has been offered to those patients presenting with back pain and radicular symptoms or back pain alone 3 (6.0%).…”

“…Patients with severe local back pain17 without any focal neurological signs who had failed non-operative medical management for at least a period of six weeks have undergone less invasive percutaneous vertebroplasty with bone cement…”