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Vertebral hemangiomas or haemangiomas (VHs) are a common vascular lesion found within the vertebral body of the thoracic and lumbar spine. These are predominantly benign lesions that are often found incidentally during radiology studies for other indications and can involve one or multiple vertebrae. Vertebral hemangiomas are a common etiology estimated to be found in 10-12% of humans at autopsy. They are benign in nature and frequently asymptomatic. Symptoms, if they do occur, are usually related to large hemangiomas, trauma, the hormonal and hemodynamic changes of pregnancy (causing intra-spinal bleeding), or osseous expansion and extra-osseous extension into surround soft tissues or epidural region of the spinal canal.
Vertebral hemangiomas are observed throughout any age, although most are diagnosed in people within their 50s alongside a higher presence in females with a 1:1.5 male-to-female ratio. They often present in the vertebral body of the thoracic and lumbar spine with potential to extend into the posterior arch. They can involve a single or multiple vertebrae.
Hemangiomas can display typically and atypically. Typical VHs have predominant fat overgrowth that present throughout various scanning techniques differently compared with atypical VHs that have less fat and more vascular content (see diagnosis).
Most hemangiomas present asymptomatically and only found incidentally through MRI, CT, or radiography. However, hemangiomas can become symptomatic in around 1% of cases.
In these rare cases, hemangiomas present active behavior and are known as aggressive or compressive VHs. When symptomatic, they can cause pain and myelopathy by intra-spinal bleeding, bony expansion or extra-osseous extension into surround soft tissue or the posterior neural elements. Highly vascular (cavernous type) hemangiomas can produce neurologic deficits without prominent evidence of spinal cord compression. The deficits in these cases are probably attributable to blood flow disturbances in the spinal cord