Surgical management of vertebral fractures caused by aggressive hemangiomas. A series of case reports and a review

Relevance. Vertebral hemangioma (VH) is a combined group of spine vascular formations that destruct bone tissue of vertebrae. The clinically relevant VH forms cause pain syndrome or neurological defi t due to the progressive decrease of support ability in the affected vertebra or its pathologic fracture that occure within the clinical course of 3.6-10.9 percent of all aggressive VH. No algorithm for the surgical management of fractures in VH was found in the available studies. Th objective of this study was to determine the range of surgical techniques used for fractures in hemangioma affected vertebrae. Th ee case reports are presented. The available sources of 1983-2020 contain 15 studies on pathologic fractures associated with VH including 6 case reports and 9 reviews. They describe 3 anterior corpectomies with autograft bone substitutes, 1 vertebroplasty (kyphoplasty), 5 decompressions and anterior fi tion with a hardware, 5 transpedicular fi tions (TPF) and open vertebroplasties, 1 TPF and laminectomy. 80 percent of the outcomes featured the complete regression of neurological defi t. However, in 20 percent of the outcomes the neurological defi t never regressed completely due the long time that passed since the fractures occurred. We present three case reports that demonstrate the unique practice of surgical management for pathologic fractures in VH and involve L1 transcutaneous transpedicular balloon kyphoplasty, two-stage surgical treatment (L3-L5 transcutaneous transpedicular fi tion and L4 neoplasm biopsy+ anterior corporodesis); C7 vertebroplasty. The outcomes featured the complete reversal of pain syndrome in 1 post-op year without any loss in the induced stability.