From the Guidelines
Yes, you should consult neurosurgery for a chronic T8 fracture and T4 hemangioma. These spinal conditions warrant specialist evaluation to determine appropriate management and prevent potential complications. The neurosurgeon will assess the stability of the T8 fracture, even if chronic, as unstable fractures may require surgical intervention to prevent progressive deformity or neurological compromise. For the T4 hemangioma, while many vertebral hemangiomas are incidental findings requiring no treatment, some can be aggressive, causing vertebral weakening, pain, or neurological symptoms. The neurosurgeon will evaluate imaging studies (MRI, CT scans) to determine the size, location, and characteristics of both conditions. They may recommend conservative management with pain control and monitoring for stable, asymptomatic cases, or surgical intervention for cases with instability, progressive symptoms, or neurological compromise. Early consultation is important even for chronic conditions, as they can evolve over time and potentially impact spinal cord function or stability. According to the American College of Radiology Appropriateness Criteria 1, surgical consultation is usually appropriate for patients with pathologic fracture with neurologic effects.
Key Considerations
- The presence of a chronic T8 fracture and T4 hemangioma requires a comprehensive evaluation to determine the best course of management.
- The neurosurgeon will assess the stability of the T8 fracture and the characteristics of the T4 hemangioma to determine the risk of neurological compromise or spinal instability.
- A multidisciplinary approach, including interventional radiology, surgery, and radiation oncology consultation, may be recommended for patients with pathologic fracture and severe symptoms 1.
- Early consultation with a neurosurgeon is crucial to prevent potential complications and improve outcomes.
- The most recent and highest quality study 1 supports the recommendation for surgical consultation in patients with pathologic fracture and neurologic effects.
From the Research
Symptomatic Vertebral Hemangiomas
- Vertebral hemangiomas are benign vascular lesions of the vertebral column, but a small percentage can cause spinal cord compression and require surgical intervention 2, 3.
- Symptoms of symptomatic vertebral hemangiomas can include back pain, poor quality of life, easy fatigability, and neurological deficits such as hypoesthesia and hyperactive deep tendon reflexes 2.
Treatment Options
- Surgical intervention, including total laminectomy, tumor resection, and vertebroplasty, can be an effective treatment for symptomatic vertebral hemangiomas 2, 4.
- Transarterial embolization, with or without decompression, can also be used to treat painful intraosseous hemangiomas and reduce intraoperative blood loss 4, 5.
- Vertebroplasty can be useful for improving pain symptoms, especially when vertebral body compression fracture has occurred in patients without neurological deficit 4, 5.
Aggressive Vertebral Hemangiomas
- Aggressive vertebral hemangiomas are characterized by extra-osseous extension, bone expansion, disturbance of blood flow, and occasionally compression fractures 3.
- Complete intralesional spondylectomy following embolization can be safely accomplished for aggressive vertebral hemangiomas with circumferential vertebral involvement 5.
Management of Chronic T8 Fracture and T4 Hemangioma
- The management of a chronic T8 fracture and T4 hemangioma would depend on the presence of symptoms and the severity of the condition 4, 5, 6.
- A comprehensive management plan may include surgical intervention, embolization, and vertebroplasty, and should be tailored to the individual patient's needs 4, 5, 6.