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What Is a Spinal Hemangioma?

Mary McMahon
By
Updated Mar 03, 2024
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A spinal hemangioma is a benign vascular tumor of the spine. These growths classically appear in the thoracic and lumbar spine, located in the mid to lower back. While the tumor is not dangerous, it can cause pain and discomfort, and treatment may be recommended for these reasons. Spinal surgeons are usually involved in the evaluation and treatment of patients with spinal hemangiomas and patients can access especially good treatment at spinal centers, facilities specializing solely in spinal care.

The causes of spinal hemangiomas are not well understood. Some people appear to have a genetic predisposition, while other people do not, and the tumors can take a variety of forms. Patients can experience symptoms like pain, numbness, and tingling, both at the tumor site and in another areas of the body if the tumor puts pressure on the spinal nerves. To diagnose this condition, a doctor will need to order a medical imaging study of the spine.

Tests like MRIs are commonly used to evaluate patients with suspected spinal problems, and a contrast agent may be used to highlight the spinal structures. For this test, patients lie on a table after being injected with the contrast agent and are wheeled into an MRI machine for imaging. A radiologist can examine the images and check for abnormalities. If any are found, spine specialists can look at the films to collect more information for use in diagnosis and the development of a treatment plan.

Often, the recommendation for this condition is no treatment. If the patient is not experiencing severe symptoms and the tumor appears stable, followups will be recommended periodically to see if it is growing and to check for new symptoms, but otherwise the tumor will be left alone. For patients in pain and in cases where there are concerns about pinching the spinal nerves, treatment may be recommended to address the tumor before it has an opportunity to cause more problems for the patient.

One option is embolization, where the blood supply to the tumor is cut off, arresting the growth and forcing it to shrink over time. A spinal hemangioma can also be removed surgically or treated with radiation therapy. Once the growth is resolved, the patient should experience a significant improvement. If symptoms continue to linger, further medical evaluation is needed to check for signs of permanent damage to the spine. Treatment options for chronic pain caused by a spinal hemangioma can include electrical stimulation of the nerves, as well as pain medications.

How Fast Do Spinal Hemangiomas Grow?

For many people, a hemangioma exists for many years before it is noticed. Individuals don’t often have imaging done of the mid or lower back without cause, and it can make changes in the way an individual feels or certain neurological concerns before an x-ray, MRI or CT scan reveals the tumor. Only about 5% of the population who have a hemangioma will develop symptoms, leading to some discrepancies with how long it has existed and how much it has grown. The significant signs of damage to the spinal column, the nerves or the amount of compression experienced by the spinal cord or canal can give some insight into the overall development of the tumor.

Seeing the Signs of Growth

Doctors look for a lattice-shaped or honeycomb-looking mass within the bone to help determine where a suspected spinal hemangioma may be. When discovered and monitored, physicians find that these tumors grow very slowly. However, it is the impact on the surrounding area that determines the seriousness of the size. When the hemangioma is in one location it can cause pain, but as it grows, it can move past the boundaries of the bone and cause the vertebra to collapse.

Feeling the Signs of Growth

In turn, this puts immense pressure on the spinal cord and surrounding nerves. This can cause pain to radiate into the legs or arms, cause numbness or weakness and compromise bladder or bowel control. The progression of symptoms in an individual identifies how quickly the tumor may be growing, but the overall growth pattern is different for each individual.

Can Spinal Hemangiomas Be Cancerous?

When patients hear the word tumor, the first thoughts are generally of fear of cancer. Spinal tumors are abnormal masses of tissue that are located in or around the spinal column or spinal cord, and the growth of the cells can wreak havoc on the body when determined to be malignant or cancerous. Hemangioma is made up of abnormal blood vessels and it could mimic a malignant lesion when looking at both radiological and clinical behavior.

The organization of the hemangioma can contribute to clarifying whether this type of tumor is benign or malignant, as recurrent trauma has been thought to induce the development of a tumor as a result of mechanical irritation. The response to trauma could increase blood flow into a preexisting lesion. Hemangiomas can be defined as typical, atypical and aggressive, and once symptoms are present, imaging will determine the location and size of the tumor. While surface hemangiomas are often seen at birth, locations in the spine generally develop after 30 but are closer to age 50.

Can Spinal Hemagiomas Be Misdiagnosed?

Imaging results that reveal a mass typically generate concern for both patient and provider, and further testing is often needed to determine the exact nature of a mass. Hemangiomas of the spine are typically diagnosed through magnetic resonance imaging (MRI) or computed tomography (CAT scan). These devices produce images of the tissues and bones surrounding the spinal cord. For some scans, extra clarity is provided by injecting a patient with a contrast-enhancing agent. This can help physicians tell the difference between a metastatic or cancerous tumor and a benign hemangioma.

Recognizable Signs

There are several signs that reveal a vertebral hemangioma over a malignant tumor. One sign is thick vertical bands that have developed in the affected bone. These bands alternate in a pattern with normal bone that looks like corduroy stripes. When a horizontal cross-section of bone is scanned, the resulting sign looks more like polka-dots. This view shows circular slices of the thickened band within the normal bone tissue, resulting in the comparison to polka dots.

Diagnosis Complications

When a hemangioma is aggressive, the extraosseous extension and bone expansion can mimic the harsh impact of metastasis. This condition is the spread of cancer from an initial site to a different site within the body. The similarities between the echo reflectivity of certain hemangiomas on imaging systems and that are seen with some metastases can lead to misdiagnosis. Conducting more invasive testing on areas around the spinal column is also more challenging and risky, potentially leading to misdiagnosing these tumors as benign when they are a malignant tumor instead or vice versa.

Can Spinal Hemangiomas Be Treated?

Many healthcare providers will not recommend treating a benign hemangioma unless it has grown significantly and is impacting an individual’s quality of life. Vertebral hemangiomas that are causing neurological symptoms or substantial pain are typically the tumors treated, either through embolization, radiation therapy, removing the compromised bone or kyphoplasty. In severe cases, spinal stability may be encouraged through a bone graft and supportive hardware.

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Mary McMahon
By Mary McMahon

Ever since she began contributing to the site several years ago, Mary has embraced the exciting challenge of being a The Health Board researcher and writer. Mary has a liberal arts degree from Goddard College and spends her free time reading, cooking, and exploring the great outdoors.

Discussion Comments
By anon1002090 — On Sep 04, 2019

I have the tumors on my spine, and I have a lot of numbness in the feet and lower legs. Yes I have bulging discs in my lower back that looks like a Christmas tree. This is what I have found out that has helped me a lot. Acupuncture but not in the west, I found some relief from this in China, yes I know, China, but if you want some relief, then go to China and find a good acupuncturist. The first treatment I received was for 3.5 hours every day for 10 days. She placed upwards to 30 needles in me from my hands to my ankles. Yes it help a lot and now I go and get an maintenance tune up every so often. So if you want relief, then come or go to China and see the doctor, okay?

By anon989398 — On Mar 04, 2015

I use cannabis. The pain and numbness are still there, but it helps to take my mind off of it, in essence taking the pain away.

By peekh — On Jan 26, 2013

Are there alternative treatments for people with spinal hemangiomas? If so, what are they? I have a similar situation as anon164370. Much of the literature regarding multiple spinal hemangiomas recommends a non-surgical approach. I also found a website for AVM (arteriovenous malformation) which can be of the brain or spine. It is surprising to learn that this disease is more common or widespread than I had imagined. It also appears to be genetic in many cases.

In addition to the hemangioma, I have a meningioma in the left frontal lobe of my brain. I have not had surgery. I have numbness of arms/legs and spasms in my back plus extreme pain and bad migraines. Seems to be a common problem with all.

By anon316071 — On Jan 26, 2013

I also have multiple spinal hemangiomas (T5 and T11), plus a meningioma in the frontal lobe of my brain. I am not able to work due to dizzy spells, weakness on left side of body, extreme pain, numbness in hands/feet, pain in right arm/shoulder, pain in left hip/leg, nerve spasms in lower back and my neurologist tells me to just take tylenol, advil and/or aleve for pain.

My bowels don't work very well either, meaning I can't evacuate food sometimes for up to five days, and I'm still losing weight due to the location of the tumors. I can drink fluids without any problem.

I am seeking some relief or improvement. I went to a teaching hospital for a consult, but got no help. Does anyone have recommendations? What have people with this disease tried as alternative to surgery?

I'm not a fan of strong pain killers or shots. I think our society is flooded with addicts and I'm not thrilled about becoming dependent on pain meds.

By anon298603 — On Oct 21, 2012

@anon164370: Of course you should! It is always good to get a second opinion and sometimes a third. You are the only one who knows what you are going through, so you have to find a doctor that you trust and who listens to you. Good luck!

By anon164370 — On Mar 31, 2011

I have been diagnosed with multiple spinal hemangiomas, which are predominately at T8-T9 and in other areas of the spine. I have been told not to worry about them but in the past I have had several spinal surgeries at L4/5 area which has left me with chronic pain and damage to the nerve to the bowel.

I also experience the most awful aching pain across mid to upper area of my back plus weakness in my legs. Should I insist on a second opinion? Any comments would be much appreciated. Many thanks.

Mary McMahon
Mary McMahon

Ever since she began contributing to the site several years ago, Mary has embraced the exciting challenge of being a...

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