Background: Vertebral haemangiomas are typically benign and asymptomatic, but a small subset, known as aggressive vertebral haemangiomas, may present with neurological deficits due to extraosseous extension and spinal cord compression. These cases require timely diagnosis and a multidisciplinary management approach. Case Presentation: A 42-year-old male presented with acute onset severe mid-back pain for two months. Neurological examination revealed exaggerated reflexes without motor or sensory deficits. MRI showed expansile lesions at T7, T9 and T10, with additional angiomatous lesions at T3 and T4. T7 and T10 lesions caused spinal cord compression. Pre-operative embolization of T7 and T10 was performed using polidocanol. The patient subsequently underwent vertebroplasty at T7, T9 and T10 levels, pedicle screw fixation from T4–T11, posterior decompression at T6–T7 and T9–T10. Intra-operative biopsies revealed a cavernous haemangioma at T7 and a capillary haemangioma at T9. No malignancy was found Results: Post-operative recovery was uneventful, with early mobilization and significant functional improvement. At 2-year follow-up, the patient had no pain or neurological symptoms and radiographs showed stable fixation with no recurrence. Conclusion: Aggressive vertebral haemangiomas, though rare, should be considered in patients with progressive neurological symptoms. Early diagnosis, embolization, surgical decompression and stabilization can yield excellent outcomes.
Saran et al. (Mon,) studied this question.