What question did this study set out to answer?

The aim is to evaluate the effectiveness of a multimodal approach in managing vertebral hemangiomas while minimizing complications.

March 21, 2026Open Access

Is multimodal approach the preferable strategy for vertebral hemangioma management: Our experience with case series of nine patients

Key Points

The aim is to evaluate the effectiveness of a multimodal approach in managing vertebral hemangiomas while minimizing complications.
Retrospective case series of nine patients treated between June 2015 and September 2019.
Patients categorized as having nonaggressive or aggressive vertebral hemangiomas.
Interventions included transarterial embolization, percutaneous ethanol injection, vertebroplasty, and varied surgical options.
At least two treatment modalities were utilized for each patient.
All surgical patients showed improvement on ASIA and Nurick scales, with one exception.
Four nonsurgical patients had an ODI score of less than 10% at last follow-up.
Follow-up MRI demonstrated no recurrence of vertebral hemangiomas.

Abstract

Introduction: In the management of vertebral hemangioma (VHs), a conventional surgical approach may cause a huge amount of blood loss leading to coagulopathy and may even result in death. A multimodal approach, consisting of transarterial embolization, percutaneous ethanol injection, and vertebroplasty, allows for circumventing these dreaded complications. In this retrospective case series, we depict the results of multidisciplinary approach for treatment of VHs. Materials and Methods: The variables of the patients who were treated for VH between June 2015 and September 2019 were incorporated. Preintervention considerations: Four patients presented with nonaggressive hemangiomas, with back pain being their chief complaint. Their Oswestry Disability Index (ODI) scores were 61% and higher. The rest five patients had symptomatic and aggressive hemangiomas. There was neurological involvement in these patients. Their preoperative ASIA-Impairment Scale and Nurick scores ranged from B to D and 2–5, respectively. Intervention: Our intervention was broadly classified into surgical and nonsurgical. We chose a multidisciplinary approach in every case. We delivered at least two modalities in each case. The nonsurgical cases were dealt with transarterial embolization, percutaneous ethanol injection, or vertebroplasty. Surgical intervention was also integrated with other modalities, including embolization, ethanol, and/or vertebroplasty, on a case-to-case basis. Results: The follow-ups varied from 1.5 years to 6 years. All surgical cases showed E on ASIA-scale and Nurick grade 1, except for 1 case of revision which was D and 2 on ASIA and Nurick scale, respectively. The four nonsurgical patients showed an ODI score of <10% in the last assessment. Follow-up magnetic resonance imaging showed no evidence of recurring lesion. Conclusion: Our experience leads to the inference that for management of symptomatic VH, individualized multimodal approach should be an established protocol. We have experienced that acceptable lesion obliteration with lesser morbidity can be achieved by following this strategy.

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