Surgical tactics in aggressive hemangiomas of the spine with spinal stenosis

Introduction. Stage III aggressive vertebral hemangiomas according to the Enneking classification are characterized by extraosseous growth and often lead to spinal canal stenosis and neurological deficits. Standard percutaneous vertebroplasty is contraindicated in these cases due to the high risk of neurological complications. The preferred treatment strategy for aggressive vertebral hemangiomas with neurological compromise is spinal canal decompression followed by open, controlled vertebroplasty. The aim of this study is to determine the optimal treatment strategy for Enneking Stage III hemangiomas with spinal canal stenosis. Materials and methods. A retrospective analysis was conducted on 32 patients (mean age 44.5 years) with aggressive hemangiomas complicated by spinal canal stenosis and neurological deficits (grades A–D on the Frankel scale). All patients underwent the same surgical procedure, which included a dorsal approach, transpedicular fixation, laminectomy, open vertebroplasty with bone cement, and removal of the tumor’s soft-tissue component. Results. Surgical treatment led to significant improvement in neurological status in the majority of patients. The Visual Analogue Scale pain score decreased from 7.1 to 1.7 points at 6 months postoperatively. The mean intraoperative blood loss was 854 ml. Tumor recurrence was noted in three patients, associated with an insufficient volume of injected cement (50 %). The potential for full recovery was largely determined by the timeliness of the intervention: the best outcomes were observed in patients with a shorter duration of spinal cord compression syndrome and before the formation of irreversible myelopathic changes. Conclusion. Decompressive-stabilizing surgery with open vertebroplasty is an effective treatment for aggressive hemangiomas with stenosis, allowing for significant neurological improvement and pain relief. Key success factors are adequate filling of the vertebral body with cement to occlude blood flow and mandatory removal of the extraosseous tumor component to prevent recurrence.