Open vertebroplasty for cervical spine aggressive hemangioma

Objective.To analyze results of open vertebroplasty for aggressive hemangioma of the cervical spine.

Material and Methods. Surgical treatment was performed in 12 patients with aggressive hemangioma of the cervical spine. Vertebroplasty was performed through an open anterolateral approach under the control of an image intensifier.

Results. Pain intensity was 7.0 ± 1.0 on VAS before surgery and 1.8 ± 1.2 immediately after surgery. Neck disability index (NDI) was 17.5 ± 6.5 before surgery and 4.3 ± 1.7 after surgery. One month after surgery VAS and NDI scores were 0. There were no complications in the postoperative period. A control study visualized from 82 % to 98 % completeness of filling the bone defect with polymethyl methacrylate. Bone composite migration outside the vertebral body was not detected in any of the operated patients. Control images taken 6 and 12 months after surgical treatment did not reveal continued tumor growth and signs of any osteonecrotic processes in bone tissue as a response to PMMA bone cement in any case.

Conclusion. Despite the widespread and rather long period of using vertebroplasty, the issues of the choice of approaches when performing it on the cervical spine are still debatable. In order to reduce the risk of iatrogenic complications in cervical vertebroplasty, the open approach can be used which increases the treatment effectiveness.

1. Мусаев Э.Р. Первичные опухоли позвоночника: обзор литературы // Практическая онкология. 2010. Т. 11. № 1. С. 19–24. [Musaev ER. Primary tumors of the spine: literature review. Practical Oncology. 2010;11(1):19–24. In Russian].

2. Кравцов М.Н., Мануковский В.А., Манащук В.И., Свистов Д.В. Диагностика и лечение агрессивных гемангиом позвонков // Клинические рекомендации. М., 2015. С. 35. [Kravtsov MN, Manukovsky VA, Manashchuk VI, Svistov DV. Diagnosis and treatment of aggressive vertebral hemangiomas: Clinical guidelines. Moscow. 2015:35. In Russian].

3. Климов В.С., Косимшоев М.А., Евсюков А.В., Киселев В.С., Воронина Е.И. Результаты дифференцированного хирургического лечения агрессивных гемангиом позвонков // Хирургия позвоночника. 2018. Т. 15. № 1. С. 79–90. [Klimov VS, Kosimshoev MA, Evsyukov AV, Kiselev VS, Voronina EI. Results of differentiated surgical treatment of aggressive vertebral hemangiomas. Hir. Pozvonoc. 2018;15(1):79–90. In Russian]. DOI: 10.14531/ss2018.1.79-90.

4. Urrutia J, Postigo R, Larrondo R, San Martin A. Clinical and imaging findings in patients with aggressive spinal hemangioma requiring surgical treatment. J Clin Neurosci. 2011;18:209–212. DOI: 10.1016/j.jocn.2010.05.022.

5. Зарецков В.В., Лихачев С.В., Арсениевич В.Б., Степухович С.В., Салина Е.А. Гемангиомы позвоночника. Особенности диагностики и хирургического лечения // Успехи современного естествознания. 2015. № 6. С. 22–27. [Zaretskov VV, Likhachev SV, Arsenievich VB, Stepukhovich SV, Salina EA. Vertebral hemangiomas: Diagnostics and surgical treatment. Advances in Current Natural Sciences. 2015;(6):22–27. In Russian].

6. Рерих В.В., Рахматиллаев Ш.Н., Пендюрин И.В. Результаты хирургического лечения пациентов с гемангиомами грудных и поясничных позвонков (опыт Новосибирского НИИТО) // Международный журнал прикладных и фундаментальных исследований. 2015. Т. 11. № 1. С. 55–59. [Rerikh VV, Rakhmatillaev SN, Pendjurin IV. Results of surgical treatment of patients with hemangiomas of the thoracic and lumbar spine (experience of the Novosibirsk NRITO). International journal of applied and fundamental research. 2015;11(1):55–59. In Russian].

7. Gajaseni P, Labianca L, Lacerda I, Weinstein S. A child with a rare extraosseous extension and pathologic fracture from a vertebral hemangioma: a case report. JBJS Case Connect. 2017;7:e86. DOI: 10.2106/JBJS.CC.17.00057.

8. Воронович И.Р., Пашкевич Л.А., Мартынюк С.Н. Гемангиома позвоночника // Медицинские новости. 2014. № 1. С. 39–42. [Voronovich IR, Pashkevich LA, Martynyuk SN. Hemangioma of the spine. Meditsinskie novosti. 2014;(1):39–42. In Russian].

9. Jiang L, Liu XG, Yuan HS, Yang SM, Li J, Wei F, Liu C, Dang L, Liu ZJ. Diagnosis and treatment of vertebral hemangiomas with neurologic deficit: a report of 29 cases and literature review. Spine J. 2014;14:944–954. DOI: 10.1016/j.spinee.2013.07.450.

10. Курамшин А.Ф., Сафин Ш.М., Нагаев Р.Я., Суфианов А.А., Манащук В.И., Шишигин А.В., Киреенко Т.Г. Особенности проведения вертебропластики при гемангиомах шейного отдела позвоночника // Хирургия позвоночника. 2015. Т. 12. № 4. С. 80–83. [Kuramshin AF, Safin SM, Nagaev RY, Sufianov AA, Manashchuk VI, Shishigin AV, Kireenko TG. Vertebroplasty for cervical spine hemangioma. Hir. Pozvonoc. 2015;12(4):80–83. In Russian]. DOI: 10.14531/ss2015.4.80-83.

11. Nguyen JP, Djindjian M, Pavlovitch JM, Badiane S. [Vertebral hemangioma with neurologic signs. Therapeutic results. Survey of the French Society of Neurosurgery]. Neurochirurgie. 1989;35:299–303. In French.

12. Гармиш А.Р. Особенности техники и анатомическое обоснование выбора пункционных доступов при лечении агрессивных гемангиом позвоночника методом пункционной вертебропластики // Український нейрохірургічний журнал. 2003. № 2. С. 78–82. [Garmish AR. Technical features and anatomical background of choice of percutaneous vertebroplasty for aggressive vertebral hemangiomas. Ukrainian Neurosurgical Journal. 2003;(2):78–82. In Russian].

13. Stangenberg M, Viezens L, Eicker SO, Mohme M, Mende KC, Dreimann M. Cervical vertebroplasty for osteolytic metastases as a minimally invasive therapeutic option in oncological surgery: outcome in 14 cases. Neurosurg Focus. 2017;43:1–8.

14. Kordecki K, Lewszuk A, Pulawska-Stalmach M, Michalak P, Lukasiewicz A, Sackiewicz I, Polakow P, Rutka K, Lebkowski W, Lebkowska U. Vertebroplasty of cervical vertebra. Pol J Rdiol. 2015;80:51–56. DOI: 10.12659/PJR.892165.

15. Floeth F, Turowski B, Herdmann J. Partial corporectomy and open vertebroplasty via an anterolateral approach for metastatic destruction of the axis. J Neurol Surg A Cent Eur Neurosurg. 2012;73:106–110. DOI: 10.1055/s-0032-1309066.

16. Shetty SR, Ganigi PM, Mandanna BK. Open C2 vertebroplasty: case report, technique, and review of literature. Asian J Neurosurg. 2017;12:710–714. DOI: 10.4103/ajns.AJNS_46_15.

17. Зарецков В.В., Арсениевич В.Б., Лихачев С.В., Степухович С.В., Мизюров С.А.

18. Оперативное лечение агрессивных гемангиом переходного шейно-грудного отдела позвоночника у детей (клинические наблюдения, предварительные результаты) // Ортопедия, травматология и восстановительная хирургия детского возраста. 2019. Т. 7. № 2. С. 79–86. [Zaretskov VV, Arsenievich VB, Likhachev SV, Stepukhovich SV, Mizyurov SA. Surgical treatment of aggressive hemangiomas of the transitional cervical-thoracic spine in children (сlinical observations, preliminary results). Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2019;7(2):79–86. In Russian]. DOI: 10.17816/PTORS7279-86.

19. Clarencon F, Fahed R, Cormier E, Haffaf I, Spamno JP, Shotar E, Premat K, Bonaccorsi R, Degos V, Chiras J. Safety and effectiveness of cervical vertebroplasty: report of a large cohort and systematic review. Eur Radiol. 2020;30:1571–1583. DOI: 10.1007/s00330-019-06525-w.

20. Beyaz SG, Sayhan H, Inanmaz ME, Orhan M. Cervical vertebroplasty under sedoanalgesia using combined ultrasonography and fluoroscopy guidance: a novel technique. Eur Spine J. 2018;27(Suppl 3):353–358. DOI: 10.1007/s00586-017-5276-3.

21. Bao L, Jia P, Li J, Chen H, Dong Y, Feng F, Yang H, Chen M, Tang H. Percutaneous vertebroplasty relieves pain in cervical spine metastases. Pain Res Manag. 2017;2017:3926318. DOI: 10.1155/2017/3926318.

22. Кущаев С.В., Педаченко Е.Г., Потапов А.А., Красиленко Е.П. Пункционная вертебропластика при агрессивной гемангиоме в шейном отделе позвоночника (клинический случай) // Вiсник СумДУ. Медицина. 2008. № 2. Т. 2. С. 78–83. [Kushayev SV, Pedachenko EG. Potapov AA, Krasilenko EP. Closed vertebral plasty at aggressive hemangioma in cervical part of spinal cord (clinical case). Sumy State University Bulletin, series Medicine. 2008;2(2):78–83. In Russian].