From the Guidelines
Yes, intraosseous hemangiomas can cause back pain. These benign vascular tumors that develop within the vertebrae can lead to pain when they grow large enough to weaken the bone structure, causing vertebral collapse or compression of nearby nerve roots 1. The pain is typically localized to the affected vertebra and may worsen with activity or prolonged standing. Some patients experience radiating pain if there is nerve compression. Many intraosseous hemangiomas are asymptomatic and discovered incidentally on imaging, but symptomatic cases often require treatment.
Management Options
Management options include:
- Observation for mild cases
- Pain medications (NSAIDs, acetaminophen)
- Vertebroplasty or kyphoplasty to stabilize weakened vertebrae
- Radiation therapy to reduce the size of the hemangioma
- Surgery for severe cases with neurological compromise The pain mechanism relates to the hemangioma's disruption of normal bone architecture, creating structural weakness and potential microfractures that stimulate pain receptors in the periosteum and surrounding tissues. According to the most recent study 1, imaging plays a crucial role in diagnosing and treating thoracic back pain, including cases caused by intraosseous hemangiomas.
Key Considerations
Key considerations in managing intraosseous hemangiomas include:
- Assessing the integrity of the soft tissue and neural structures
- Evaluating the presence of spinal hardware and its integrity
- Using imaging modalities such as radiographs, CT, or MRI to guide treatment planning
- Considering the potential for spinal instability and the need for stabilization procedures 1.
From the Research
Intraosseous Hemangioma and Back Pain
- Intraosseous hemangiomas are benign tumors that can occur in the bones of the spine and other parts of the skeleton.
- According to a study published in 2006 2, intraosseous hemangiomas can cause back pain, and treatment options such as transarterial embolization, surgical decompression, and vertebroplasty can provide pain relief.
- The study found that transarterial embolization alone was an effective treatment for painful intraosseous hemangiomas, with three out of four patients experiencing resolution of back pain.
Imaging Characteristics of Intraosseous Hemangiomas
- Imaging studies, such as radiography, CT, and MRI, can help diagnose intraosseous hemangiomas and evaluate their extent and location.
- A study published in 2023 3 found that intraosseous hemangiomas outside of the mobile spine and calvarium can demonstrate aggressive imaging features, including cortical permeation, soft tissue mass, and increased FDG activity.
- Another study published in 2020 4 found that MRI can help define the location and extent of intraosseous hemangiomas in long tubular bones, and that the tumor usually shows high signal intensity on T2-weighted imaging and intermediate signal intensity on T1-weighted imaging.
Treatment Options for Intraosseous Hemangiomas
- Treatment options for intraosseous hemangiomas depend on the location, size, and symptoms of the tumor.
- A study published in 2021 5 found that surgical resection and radiotherapy can improve overall survival in patients with aggressive spinal hemangiomas.
- The study published in 2006 2 also found that vertebroplasty can be useful for improving pain symptoms, especially when vertebral body compression fracture has occurred in patients without neurological deficit.