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Journal of Bone and Joint Surgery - British Volume, Vol 89-B, Issue 4, 495-502.
doi: 10.1302/0301-620X.89B4.18121  
Copyright © 2007 by British Editorial Society of Bone and Joint Surgery
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Balloon kyphoplasty as a single or as an adjunct procedure for the management of symptomatic vertebral haemangiomas

A. Hadjipavlou, MD, MSc, FACS, FRCS(C), Professor and Chairman1; T. Tosounidis, MD, Resident in Orthopaedic Surgery1; I. Gaitanis, MD, Orthopaedic Surgeon1; K. Kakavelakis, MD, MSc, Resident in Orthopaedic Surgery1; and P. Katonis, MD, Assistant Professor1

1 Division of Spine Surgery, Department of Orthopaedic Surgery and Traumatology University of Crete, Heraklion 71110, Crete, Greece.

Correspondence should be sent to Professor A. Hadjipavlou; e-mail: ahadjipa{at}med.uoc.gr

Vertebral haemangiomas are usually asymptomatic and discovered fortuitously during imaging. A small proportion may develop variable degrees of pain and neurological deficit. We prospectively studied six patients who underwent eight surgical procedures on 11 vertebral bodies. There were 11 balloon kyphoplasties, six lumbar and five thoracic. The mean follow-up was 22.3 months (12 to 36). The indications for operation were pain in four patients, severe back pain with Frankel grade C paraplegia from cord compression caused by soft-tissue extension from a thoracic vertebral haemangioma in one patient, and acute bleeding causing Frankel grade B paraplegia from an asymptomatic vascular haemangioma in one patient. In four patients the exhibited aggressive vascular features, and two showed lipomatous, non-aggressive, characteristics. One patient who underwent a unilateral balloon kyphoplasty developed a recurrence of symptoms from the non-treated side of the vertebral body which was managed by a further similar procedure.

Balloon kyphoplasty was carried out successfully and safely in all patients; four became asymptomatic and two showed considerable improvement. Neurological recovery occurred in all cases but bleeding was greater than normal. To avoid recurrence, complete obliteration of the lesion with bone cement is indicated. For acute bleeding balloon kyphoplasty should be combined with emergency decompressive laminectomy. For intraspinal extension with serious neurological deficit, a combination of balloon kyphoplasty with intralesional alcohol injection is effective.




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Balloon kyphoplasty as part of the treatment of symptomatic vertebral hemangiomas
Peter L Munk, et al.
J Bone Joint Surg Br Online, 17 Aug 2007 [Full text]

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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General