As per Michael Rubin, MDCM , and Cary Cook BSN, RN.
A haemangioma is a vascular mass that is most commonly found in the thoracic spine. It can be progressive, weaken the vertebrae and even cause it to collapse as it infiltrates the bony structure. This weakening of the vertebral body and growing mass can put pressure on the spinal cord in rare cases, resulting in partial paralysis if not treated.
It is estimated that spinal haemangioma occur in about ten percent of the world’s population, but less than one percent cause symptoms. In those cases, though, it is very important to receive proper treatment to maintain stability and function of the spine and legs. Fortunately, haemangioma are not cancerous.
Treatment depends on where the tumor is located, how large it is, whether it is symptomatic and how much infiltration there is into the vertebra. The tumor can grow into the body or round solid part of the vertebra and make holes in it. The vertebra may then collapse which can damage the spinal cord and spinal nerves along with causing severe pain and dysfunction.
In this case, the haemangioma is at the 9th thoracic vertebra, and has expanded into the spinal column, pressing on the spinal cord. The plan is to remove the mass, remove the vertebra, a procedure called a corpectomy, and insert hardware and likely fuse the level above and below to ensure stability of that area of the spine.
Sometimes treatment involves embolization of the hemangioma. This treatment involves injecting a substance to stop blood flow into the mass, with the idea that reducing blood flow will reduce the size of a vascular tumor. This is not always an option. The treatment plan may involve radiation therapy in addition to surgery. This is done to prevent a recurrence, but again, whether it is appropriate depends on the specific situation.
The surgery itself also varies with the particulars of the case
Acute transverse myelitis is acute inflammation of gray and white matter in one or more adjacent spinal cord segments, usually thoracic. Causes include multiple sclerosis, neuromyelitis optica, infections, autoimmune or post infectious inflammation, vasculitis, and certain drugs. Symptoms include bilateral motor, sensory, and sphincter deficits below the level of the lesion. Diagnosis is usually by MRI, CSF analysis, and blood tests. IV corticosteroids and plasma exchange may be helpful early. Otherwise, treatment is with supportive measures and correction of any causes.
Acute transverse myelitis is most commonly due to multiple sclerosis but can occur with vasculitis, mycoplasmal infections, Lyme disease, syphilis, TB, or viral meningoencephalitis or in patients taking amphetamines, IV heroin, or ant parasitic or antifungal drugs. Transverse myelitis occurs with optic neuritis in (Devic disease), once considered a variant of multiple sclerosis but now considered a distinct disorder. The mechanism of transverse myelitis is often unknown, but some cases follow viral infection or vaccination, suggesting an autoimmune reaction. Inflammation tends to involve the spinal cord diffusely at one or more levels, affecting all spinal cord functions.
Symptoms and Signs
Pain in the neck, back, or head may occur. A band like tightness around the chest or abdomen, weakness, tingling, numbness of the feet and legs, and difficulty voiding develop over hours to a few days. Deficits may progress over several more days to a complete transverse sensorimotor myelopathy, causing paraplegia, loss of sensation below the lesion, urinary retention, and fecal incontinence. Occasionally, position and vibration sensation are spared, at least initially. The syndrome occasionally recurs in patients with multiple sclerosis, SLE, or antiphospholipid syndrome.
Diagnosis
- MRI and CSF analysis
- Other tests to identify treatable causes
Diagnosis is suggested by transverse sensorimotor myelopathy with segmental deficits. Guillain-Barré syndrome can be distinguished because it does not localize to a specific spinal segment. Diagnosis requires MRI and CSF analysis. MRI typically shows cord swelling if transverse myelitis is present and can help exclude other treatable causes of spinal cord dysfunction (eg, spinal cord compression). CSF usually contains monocytes, protein content is slightly increased, and IgG index is elevated (normal, ≤ 0.85).
A test for a marker for neuromyelitis optica IgG (NMO-IgG)—an autoantibody that targets the astrocyte water channel protein aquaporin-4—is highly specific and helps distinguish neuromyelitis optica from multiple sclerosis.
Tests for treatable causes should include chest x-ray; PPD; serologic tests for mycoplasmal, Lyme disease, and HIV; vitamin B, folate, zinc, and copper levels; ESR; antinuclear antibodies; and CSF and blood Venereal Disease Research Laboratory (VDRL) tests. History may suggest a drug as a cause.
Brain MRI is done; multiple sclerosis develops in 50% of patients who have multiple per ventricular T2 bright lesions and in 5% who do not have them.
Prognosis
Generally, the more rapid the progression is, the worse the prognosis. Pain suggests more intense inflammation. About one third of patients recover, one third retain some weakness and urinary urgency, and one third are bedbound and incontinent. Multiple sclerosis eventually develops in about 10 to 20% of the patients in whom the cause is initially unknown.
Treatment
- Treatment of the cause, Sometimes corticosteroids
Treatment is directed at the cause or associated disorder but is otherwise supportive. In idiopathic cases, high-dose corticosteroids are often given and sometimes followed by plasma exchange because the cause may be autoimmune. Efficacy of such a regimen is uncertain.
Sources:
OrthoSuperSite: Spinal Cord Compression Due to Vertebral Hemangioma
http://www.orthosupersite.com/view.aspx?rid=25689
Spine Universe: Spinal Tumors: Descriptive Overview
http://www.spineuniverse.com/conditions/spinal-tumors/spinal-tumors-desc…
University of Southern California Center for Spine Surgery: Anterior Lumbar Corpectomy and Fusion
http://www.uscspine.com/treatment/corpectomy-fusion.cfm
Steve Ramsey, PhD. Public Health.