Early percutaneous treatment of an aggressive vertebral hemangioma: A case report with a 5-year follow-up

Vertebral hemangiomas (VHs) are very common radiological findings, and the majority of them are completely asymptomatic and harmless. However, although rarely, they can present as locally aggressive, symptomatic lesions, and requiring surgery. In these cases, early diagnosis and treatment are mandatory to avoid serious complications and invasive surgery; however, there is no consensus about the best therapeutic option. Minimally-invasive percutaneous techniques have recently gained interests as a therapeutic option. A case of a 58-year-old male with a symptomatic aggressive VH of L5 presenting with untractable low back and radicular pain without neurological deficits is reported. An early percutaneous procedure with selective embolization combined with biportal kyphoplasty of L5 was performed. No complications and a very low-intraoperative bleeding were reported. The patient has been monitored for the following 5 years with a good outcome and with no signs of recurrence. This case report highlights the importance of making the right diagnosis and the advantages of an early percutaneous treatment with selective embolization and augmentation to avoid major open surgery with high risks.