Galley Proof 19/07/2013; 8:47 File: bmr425.tex; BOKCTP/fphu p. 1 Journal of Back and Musculoskeletal Rehabilitation 00 (2013) 1–5 1 DOI 10.3233/BMR-130425 IOS Press Aggressive vertebral hemangioma as a rare cause of myelopathy Hidayet Sari a , Murat Uludag a,∗ , Ulku Akarirmak a , Nurettin Irem Ornek a , Kerem Gun a and Fatih Gulsen b a Department of Physical Medicine and Rehabilitation, Istanbul University Cerrahpa¸ sa Medical Faculty, Istanbul, Turkey b Department of Interventional Radiology, Istanbul University Cerrahpa¸ sa Medical Faculty, Istanbul, Turkey Abstract. Vertebral hemangiomas (VHs) are common lesions in the adult population. They are usually asymptomatic and found incidentally on radiological imaging. New-onset back pain followed by subacute progression of thoracal myelopathy is the most common presentation in patients with neurological deficit. Differential diagnoses would include metastasis, multiple myeloma, lymphoma, Paget disease, osseous tumors such as Ewing sarcoma or hemangioblastoma and blood dyscrasia. We present a 41 year-old-male patient with thoracal VH causing myelopathy that completely improved after rehabilitation program with em- bolization and vertebroplasty procedures. Keywords: Aggressive hemangioma, embolization, myelopathy, thoracal vertebra, vertebroplasty 1. Introduction 1 Vertebral hemangiomas (VHs) are benign develop- 2 mental hamartomas of vascular tissue that do not grow 3 by mitotic activity and therefore do not possess ma- 4 lignant potential [1,2]. VHs are common with an esti- 5 mated incidence of 10–12% of the population based on 6 studies of large series of autopsies as well as reviews 7 of x-rays and magnetic resonance scans [3]. 8 Differential diagnoses would include metastasis, 9 multiple myeloma, lymphoma, Paget disease, osseous 10 tumors such as Ewing sarcoma or hemangioblas- 11 toma [4] and blood dyscrasia. Although the reported 12 incidence of VHs causing compressive neurological 13 symptoms is infrequent, this condition must be in- 14 cluded in the differential diagnosis when a patient 15 presents with symptoms of a progressive myelopathy. 16 New-onset back pain followed by subacute progression 17 of thoracal myelopathy is the most common presenta- 18 * Corresponding author: Murat Uludag, Tahtakale Mah. T45 Sok. Bizimevler Sitesi A1 D27 Avcılar-Istanbul, Turkey. Tel.: +90 505 9247871; Fax: +90 212 6320033; E-mail: muludag1@yahoo.com. tion in patients with neurological deficit. These lesions 19 can cause symptoms by multiple etiologies, including 20 epidural expansion of tumor tissue, expansion of bony 21 elements, expansion of feeding vessels, epidural hem- 22 orrhage or rarely by compression fracture of the verte- 23 bra [1–6]. 24 In 1987 Deramond et al. firstly described the use of 25 vertebroplasty for the treatment of aggressive vertebral 26 haemangiomas [7]. 27 We present a 41 year-old-male patient with thoracal 28 VH causing myelopathy. Patient had the normal lower 29 extremity muscle strength and was able to walk inde- 30 pendently after rehabilitation program with emboliza- 31 tion and vertebroplasty procedures. 32 2. Case 33 A 41-year-old male patient presented to our hospi- 34 tal with back pain and weakness and numbness in the 35 lower limbs for 2 months. There was no history of 36 trauma. Slight spinal tenderness of mid-dorsal region 37 was present. There was a full range of spinal move- 38 ment with only minimal pain. Numbness in the per- 39 ISSN 1053-8127/13/$27.50 c  2013 – IOS Press and the authors. All rights reserved