Результаты дифференцированного хирургического лечения агрессивных гемангиом позвонков

Objective. To evaluate the outcomes of the differentiated surgical treatment in patients with aggressive vertebral hemangiomas. Material and Methods . The study included 127 patients with aggressive vertebral hemangiomas operated on in 2013–2016. The tumor localization was cervical in 9.5% of cases, thoracic in 59.8 % and lumbar in 30.7 %. Patients were divided into two groups: Group I (n = 110) with type IIIA aggressive hemangiomas, and Group II (n = 17) with type IIIB aggressive hemangiomas. Preoperative assessment included clinical and neurological examination, VAS, ODI, JOA, Weinstein-Boriani-Biagini classification, and radiography; MSCT and MRI studies of the spine were performed before treatment and in 12 months after surgery. Results. Patients in Group I underwent puncture vertebroplasty. Back pain was 6 VAS, after 12 months – 2 VAS. The average preoperative ODI score was 32 and decreased to 9 in 12 months after surgery. In Group II, patients underwent decompression and stabilization with intraoperative open vertebroplasty of the affected vertebra. Preoperative embolization of tumor vessels was performed in two of 17 patients to reduce intraoperative blood loss. Preoperative back pain was 6 VAS, in 12 months after surgery – 2 VAS. The ODI score showed the improvement in all patients as compared to preoperative values. Conclusion . Puncture vertebroplasty ensures the achievement of good functional result in 95.4 % of cases of type IIIA aggressive hemangioma. Decompression and stabilization surgery with intraoperative open vertebroplasty provides good functional result in 93.4 % of cases of type IIIB aggressive hemangioma. The use of vertebroplasty in type IIIB aggressive hemangiomas allows for vertebral segment stabilization with a low risk of the tumor recurrence.