Clinical Evaluation of Preoperative Embolization, Vertebroplasty, and Decompression in the Treatment of Aggressive Vertebral Hemangiomas

Background: Symptomatic aggressive vertebral hemangioma often requires clinical treatment; however, there is great controversy over the treatment plan. We aimed to evaluate the efficacy and safety of different methods including preoperative emobilization, vertebroplasty, decompression and internal fixation in the treatment of aggressive hemangioma. Methods: : A retrospective clinical review of patients diagnosed with aggressive vertebral hemangiomas was conducted. All the patients were assigned to 3 groups according to the treatment strategies: patients in Group A underwent embolization before decompression, patients in Group B underwent decompression with vertebroplasty, patients in Group C received all three treatments. Clinical indexes were compared within 3 groups. Results: : There were 6 patients received embolization and decompression (Group A), 9 patients underwent decompression with vertebroplasty (Group B) and 6 patients in Group C. The operative duration of patients in group A (198.33±38.43 min) were less than another two groups (P=0.001). The intra-operative blood loss of patients in group C was 713.33±165.13ml, which was significantly less than group A and group B (P=0.045). Patients in group C exhibited the lowest volume of drainage on POD 1 (178.33±66.76ml), which showed significant difference compared with group A (368.33±191.15ml, P=0.01). There was no significant difference of pre-operative and post-operative VAS and JOA score among 3 groups, as well as drainage on POD 2, total volume and hospital duration. Conclusion: The treatment strategy of combined embolization, vertebroplasty and decompression fixation is efficient and safe. For special patients, if such a strategy cannot be adopted, simple embolization plus decompression or vertebroplasty plus decompression is also competent.