Pregnant Patient with Aggressive Thoracic Vertebral Hemangioma Causing Lower Limbs Spastic Paresis

Introduction: Vertebral hemangiomas are common tumors that are benign and generally asymptomatic. Occasionally these lesions can exhibit aggressive features such as bony expansion and erosion into the epidural space resulting in neurological symptoms. Surgery is often recommended in these cases, especially if symptoms are severe or rapidly progressive. One of the greatest risks of surgical intervention is uncontrollable hemorrhage.

Case Report: A 24 year old generally healthy pregnant lady (gestational age 36 weeks ), 2 weeks prior to her admission complained of mid thoracic back pain, in the last few days progressive weakness in her legs and sensory deficit (Incomplete Spinal cord injury-ASIA C).

She underwent Thoracic spine- CT and subsequent MRI, which revealed an aggressive vertebral hemangioma centered within T4 vertebral body, with bony and soft tissue extension into the spinal canal and posterior elements with signs of cord compression.

Before the spine surgery, our patient underwent urgent caesarian section, followed by pre-surgical embolization of the tumor to minimize bleeding during the operation.

Then she underwent posterior decompression (tumor mass resection, total T4 corpectomy and laminectomy), anterior column reconstruction with cage &bone graft, and posterior fusion (T3-T5).

During the spine surgery, she received 5 units of packed RBC.

After surgery, progressive improvement in her neurological status.

She was discharged to rehabilitation. At 5 months follow up, she can walk on her both legs without assisted devices -improved to ASIA E status and her infant in good general health.

Histopathology confirmed the lesion to be a hemangioma.

Conclusion: Despite being the most common tumor of the spine, vertebral hemangioma is rarely symptomatic in adults. They should be considered as differential diagnosis. Aggressive vertebral body hemangiomas can have epidural extension and cause parapareisis due to compressive myelopathy, which may result in permanent paraplegia and permanent disability if not managed proper­ly. The clinical symptoms of the patient can be relieved by arterial embolization followed by surgical decompression.