Percutaneous embolization and spondylectomy of an aggressive L2 hemangioma

Abstract

Spinal hemangiomas are commonly benign primary tumors of the spine that can result in pathologic vertebral fractures or spinal cord compression with neurologic deficit [1–3]. A 68-year-old woman presented with an L2 lesion that was discovered during workup of abdominal and lumbosacral pain. The radiological appearance was consistent with hemangioma demonstrating a T1 hypointense and T2 hyperintense expansile and lytic lesion (Fig. 1B, F, D, H) confirmed by percutaneous transpedicular biopsy. A spinal angiogram was done, but arterial embolization was avoided because of concern for distal flow to the anterior spinal artery. Therefore, direct administration of n-butyl cyanoacrylate was delivered to the tumor percutaneously via a transpedicular route (Fig. 1C, G). Two days after percutaneous embolization, the patient underwent spondylectomy of L2 vertebrae from a posterior approach with reconstruction (Fig. 2A, B).