The Surgical Treatment Analysis Of 46 Patients With Symptomatic Vertebral Hemangiomas

Objective:In this experiment,we dicussed how to elect the modus operandi of symptoms of vertebral hemangiomas,and evaluated the clinical effects by the same time.Methods:46 SVH patients,which included 21 males and 25 femals,were operated and got return visiting in the orthopaedics of Qilu Hospital of Shandong university from February 2000 to October 2015.The average age of them is 47 years (15-69 years).In these patients,42 cases are the involvments of single vertebral body,4 cases are multiple hemangioma involving multiple vertebral body; 7 cases of lesions are located in cervical spine,28 cases in thoracic vertebra, 8 cases in Lumbar,1 case in Sacral vertebra,and 2 cases involving the thoracic and lumbar spine at the same time. To check with vertebral lesions scope and determine the operation mode, all patients accepted preoperative imaging examination. For 12 patients with posterior vertebral body wall intact and no sign of spinal instability or neurological deficit, percutaneous vertebroplasty(PVP) was performed.For 10 patients who see a doctor because of the small of the back pain and nerve compression symptoms,and whose bone damage is not serious,Lamina resection decompression+plus vertebral body shape was performed. For 21patients whose erosion of Vertebral bodies and accessories is serious, tumor resection+bone transplantation +internal fixation was performed.3 patients who have vertebral hemangioma with other spinal diseasesback pain combined with nerve compression and other spinal diseases at the same time, Combined surgery was performed. Preoperative and postoperative spinal cord function(Frankel scale), complications and pain(visual analogue scale, VAS)were analyzed respectively.Results:All 12 patients who undergone PVP had no perioperative complication, the average VAS score ofthem decreased from 5.3±1.1(3～7)to1.3±0.8(0～3)(P<0.01). After follow-up of 44months(range,16-98 months),,all patients were normal except 1 patient died of other diseases. The average of blood loss during open surgeries was 2878ml(100-14000ml), The average blood loss of patients with preoperative vascular embolization was 2333ml(1000-3500ml).10 patients undergoing Lamina resection decompression+plus vertebral body shape,the average VAS score decreased from 6.3±1.3(4～8)to 1.2±0.8(0～2) (P<0.01), the average blood loss was 2410ml(100-3500ml),Preoperative spinal cord function of 6 cases of D,4 cases of E, all patients with postoperative 3 months back to E,1 cases of postoperative complication,2 cases with tumor development again.21 patients undergoing tumor resection+bone transplantation+internal fixation, the average blood loss was 3498ml(150-14000ml), the average VAS score decreased from7.2±1.5(4-9)to1.5 ±0.7(1～3) (P<0.01),20 patients spinal cord function with postoperative 3 months back to E,1 patient back to D,3 patient appear Internal fixation loosening,and make Revision surgery.3 paitents undergoing Combined surgery no perioperative complication and the average VAS score decreased from 7.0±1.0(6～8)to 1.0±1.2(0～4) (P<0.01), all patient spinal cord function with postoperative 3 months back to E. The patient undergoing Secondary surgery the VAS score decreased from 8 to 2, spinal cord function back to E.Conclusions:The results show above,we can come to a conclusion:through the undergraduate course of 46 cases of patients with symptomatic vertebral hemangioma, to patiensts who have pure local pain clinic, without spinal cord and nerve root compression symptoms, imaging examination in tumor limited, cortical bone is still full of patients with symptomatic vertebral hemangioma,PVP can help them achieve the purpose of relieving pain symptoms and preventing fractures. It is a safe and effective way of minimally invasive surgery.To those patients who performe spinal cord damage nerve compression symptoms, vertebral fracture or combined with other lesions of the spine with symptomatic vertebral hemangioma, open surgery can be chosen. For performance for spinal cord damage nerve compression symptoms, vertebral body fracture vertebrae mass damage and disease can be symptomatic patients with vertebral hemangioma, lamina resection decompression+vertebral body shape is very suitable for and effective operation method; For spinal cord or nerve root compression symptoms, patients with serious bone destruction, vertebral tumors underwent tumor resection+bone transplantation+internal fixation and Total en bloc spondylectomy are all effective way of operation.Vertebral body tumor resection, and Total en bloc spondylectomy are all effective.But they have indications respectivly at the same time.So clinical doctors must select the appropriate operation way when selecting a treatment plan with the actual conditions of patients;Preoperative tumor vascular embolization can effectively reduce the intraoperative bleeding, which will exert positive effects on the operation;For patients who must get repeated careful physical examination merging other spinal disease, we should check the source of the symptoms and do valuing surgery,then in a reasonable solution under the condition of surgery patients symptoms. For patients with tumor development or relapse again, again during the operation in the case of situation allows, we should try to achieve the complete removal of the tumor.