Aggressive Vertebral Hemangiomas Research Articles

Баллонная кифопластика в хирургическом лечении агрессивных гемангиом позвоночника (обзор литературы)

Introduction Aggressive vertebral hemangiomas occur in 10–11.5 % of the working-age population that determines social significance of the disease. Percutaneous vertebroplasty technique is normally used for the treatment of aggressive spinal hemangiomas. Cement leakage is the most common complication during vertebroplasty (40–87. 5 %). Balloon kyphoplasty is associated with a low incidence of cement leakage. Objective We aimed to analyze literature and summarize information on balloon kyphoplasty used to treat aggressive spinal hemangiomas. Material and methods The original literature search was conducted on key resources including PubMed and GoogleScholar. Literature searches included both Russian and English studies based on keywords. Results and discussion The article presents the main results of balloon kyphoplasty used as a standalone procedure and in combination with other methods of surgical treatment of aggressive spinal hemangiomas. The use of balloon kyphoplasty was shown to reduce the risk of extraspinal cement leakage. However, this aspect is represented by a small number of scientific publications in the current medical literature that emphasizes the relevance of the topic raised. Conclusion Despite the variety of available treatment options, the optimal management strategy remains controversial for aggressive forms of vertebral hemangiomas. There are no well-defined criteria and indications reported recently to be included into a well-structured algorithm for of balloon kyphoplasty in the treatment of aggressive spinal hemangiomas, and therefore the debatable questions need further investigation.

Utility of spinal angiography and arterial embolization in patients undergoing CT guided alcohol injection of aggressive vertebral hemangiomas.

The purpose of this study is to evaluate the role of spinal angiography and arterial embolization in avoiding spinal cord ischemia in patients undergoing CT-guided alcohol injection of aggressive vertebral hemangiomas. In this retrospective study, patients with vertebral hemangioma who underwent CT-guided direct alcohol injection between January 2007 and October 2018 were identified. Of 28 such patients, 26 had neurological deficits, and 2 had only back pain or radiculopathy. Direct alcohol injection without prior arterial embolization was done in 17 patients. Direct alcohol injection with prior arterial embolization was done in 11 patients. Clinical outcome was assessed immediately after the intervention and at follow-up. Three patients, who underwent alcohol injection without trans-arterial embolization, had worsening of neurological deficits in the post procedure period due to spinal cord ischemia. No complications related to spinal cord ischemia were noted in the embolization group. There was no significant difference in the outcomes between the two groups if the three patients with complications are excluded (p = 0.34). While CT-guided direct alcohol injection is effective in the management of symptomatic and aggressive vertebral hemangiomas, spinal angiography and trans-arterial embolization of the blood supply to the vertebral body hemangioma, prior to the direct transpedicular alcohol embolization of the lesion, improves the safety of the procedure.

Lifesaving Successful Embolization of Aggressive Vertebral Body Hemangioma and a Large Pulmonary Arteriovenous Malformation

Vertebral hemangiomas are incidental finding and most of the time do not necessitate immediate attention unless symptomatic. Vertebral hemangiomas can be very aggressive to the extent that they can produce cord compression and paraplegia/paraparesis. Such cases need evaluation with magnetic resonance imaging to assess the cause, extent, and mass effect on the spinal cord. Transcatheter embolization and decompression surgery are well established modes of treatment as single or combined approach. Pulmonary arteriovenous malformation (AVM) is caused by the direct communication of main pulmonary artery with pulmonary vein, leading to a high-flow right-to-left shunt. This usually presents clinically as hypoxia, cyanosis, and dyspnea. The clinical signs and symptoms vary depending on the size, number, and flow of fistula as well as the associated vascular malformations. Transcatheter embolization is a treatment of choice for pulmonary AVM. However, this method may result in incomplete resolution if the malformation is large in size or supplied by multiple feeding arteries. Surgical resection may be considered in those kinds of cases. As AVM can lead to hemodynamical instability, these lesions need to be addressed first. In this case, pulmonary AVM came to notice post surgical decompression. Here, we report a case of aggressive vertebral body hemangioma and a large pulmonary AVM in the same patient, which were treated by embolization in two different settings.

Percutaneous vertebroplasty with or without sclerotherapy for the treatment of symptomatic spinal haemangiomas: study of clinical safety and efficacy

Purpose : To illustrate safety and efficacy of percutaneous vertebroplasty (either solely performed or in combination to alcohol sclerotherapy) for treatment of symptomatic, aggressive vertebral haemangiomas in a series of consecutive patients. Material and Methods : Institutional database research from 1/1/2010 until 31/8/2020 identified 25 patients with 31 symptomatic, aggressive vertebral haemangiomas suffering from pain with or without neurologic compromise underwent percutaneous vertebroplasty either solely performed or in combination to alcohol sclerotherapy. When haemangioma was restrained to the vertebral body, percutaneous vertebroplasty was performed as the only treatment technique. When an epidural component was also present causing pressure effects upon the spinal sac, sclerotherapy was additionally performed with alcohol injection at the level of the vertebral pedicles. CT scan assessed implant distribution the morning post therapy and MRI was performed 6 months post. Numeric Visual pain scores (NVS) prior- and post-treatment were compared using Paired Samples t-Test and Wilcoxon Signed Rank Test. Results : Mean pain score prior to any therapy was 8.52 ± 1.388 NVS units. Mean pain score at 12 months post therapy was 1.68 ± 2.445 NVS units. There was a mean reduction of 6.84 ± 3.145 NVS units. The comparison of the patients’ self-reported outcomes concerning pain reduction and mobility improvement prior and post therapy was considered statistically significant (p<0.001). No complication was noted. Conclusions : Percutaneous vertebroplasty (either solely performed or in combination to alcohol sclerotherapy) seems to be a safe and efficient technique for the treatment of symptomatic, aggressive vertebral haemangiomas resulting in significant pain reduction and mobility improvement. Proper patient selection is a prerequisite for high success rate.

Doughnut vertebroplasty for circumferential aggressive vertebral hemangiomas

BackgroundTo assess the feasibility, safety and efficacy of a percutaneous doughnut vertebroplasty of circumferential aggressive vertebral hemangiomas (VHs).MethodsWe retrospectively reviewed our prospectively collected database of patients with VHs treated with...

Surgical management of symptomatic vertebral hemangiomas: A case report and literature review.

Background: Vertebral hemangiomas (VHs) are common benign tumors that only rarely become symptomatic. There is a paucity of data regarding their surgical management and outcomes. Here, we reported a case involving an aggressive cervical VH, discussed its surgical management and outcomes, and reviewed the literature.Methods: We assessed the clinical, radiological, and surgical outcomes for a patient with an aggressive cervical VH. We also performed a systematic review of the literature according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to describe surgical outcomes for symptomatic VH.Results: A total of 154 studies including 535 patients with VH were included in the study. The majority of patients were female (62.8%), the average age was 43 years, and the thoracic spine was most commonly involved (80.6%). Utilizing Odom’s criteria, outcomes were excellent in 81.7% (95% CI 73.2–90.2) of cases. For those presenting with myelopathy (P = 0.045) or focal neurological deficits (P = 0.018), outcomes were less likely to be excellent. Preoperative embolization was not associated with excellent outcome (P = 0.328).Conclusion: Surgical outcomes for VH are predominantly favorable, but aggressive VHs have the potential to cause significant residual postoperative neurological morbidity.

High-Grade Spinal Hemangioma: A National Cancer Database Analysis

Spinal hemangiomas are common primary tumors of the vertebrae. Although these tumors are most frequently benign and asymptomatic, they can rarely exhibit aggressive growth and invasion into neighboring structures. Treatment for these aggressive variants is controversial, often involving surgery, chemotherapy, and/or radiotherapy. This study sought to investigate current trends affecting overall survival (OS) using the National Cancer Database (NCDB) and to formulate treatment recommendations. The National Cancer Database was queried for spinal hemangiomas between 2004 and 2016. A Cox proportional hazards model was used to perform multivariate regression analysis of survival. Survival curves for comparative visualization of demographic and treatment factors were generated using a semiparametric Cox approach. A cohort of 102 patients with histologically confirmed spinal hemangiomas was identified in the database. Mean OS was 1.94 years. Administered treatments included partial surgical resection (n= 17), radical resection (n= 14), chemotherapy (n= 34), and radiotherapy (n= 56). Multivariate analysis revealed associations between decreased OS and advanced age (>65 years) and presence of metastasis. Cox survival analysis further revealed improved OS in patients who received surgical treatment and higher radiation dose. This retrospective analysis finding that treatment with surgical resection and/or radiotherapy is associated with increased OS constitutes the largest cohort of patients with aggressive vertebral hemangiomas to date. Given that the mean OS of the study cohort was 1.94 years, our findings suggest that the optimal treatment regimen to maximize survival should consist of early surgical resection with adjuvant high-dose radiotherapy.

Clinical evaluation of preoperative embolization, vertebroplasty, and decompression in the treatment of aggressive vertebral hemangiomas.

To evaluate the efficacy and safety of preoperative embolization and vertebroplasty in the treatment of aggressive hemangioma. A retrospective clinical review of patients diagnosed with aggressive vertebral hemangiomas was conducted. All the patients were assigned to three groups according to the treatment strategies: patients in Group A underwent embolization and decompression with internal fixation, patients in Group B underwent vertebroplasty and decompression with internal fixation, patients in Group C received all three treatments. Clinical indexes were compared within three groups. There were 16 patients received embolization and decompression (Group A), 19 patients underwent decompression with vertebroplasty (Group B) and 16 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 intraoperative blood loss of patients in group C was 713.33 ± 165.13 mL, 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 ± 66.76 mL), which showed significant difference compared with group A (368.33 ± 191.15 mL, p = 0.01). There was no significant difference of preoperative and postoperative VAS and JOA score among three groups, as well as drainage on POD 2, total volume and hospital duration. Both embolization and vertebroplasty are efficient and safe measures to reduce blood loss in the surgical treatment of aggressive vertebral hemangiomas, combination of all three methods is also competent.

Neuro Deficit Caused by Vertebral Hemangioma Enneking Stage 3: Incidence, Treatment Options and One Extraordinary Serious Case

Objective Aggressive Vertebral Hemangiomas (VH) are very rare lesions that may present with compression fractures or bony expansion and erosion into the epidural space resulting in neurological symptoms. Especially in these patients a surgical treatment is essential. We illustrate our institutional experience and discuss the relevant literature. Method Our database was searched for cases with vertebral hemangioma and the appearance of a neurological deficit between 2015 and 2020. We were able to identify one very extraordinary case which showed a very aggressive nature and resulted in paraparesis twice in the patient. Furthermore a Medline analysis was performed to identify data of this rare illness (aggressive VH, Enneking stage 3, S3) to assess the incidence and therapeutic options for this so called benign vascular tumor. Results One patient was identified in the database with an extraordinary course which resulted in paraparesis twice. A 54-year-old man presented with an acute onset of paraparesis of the legs. Contrast-enhanced magnetic resonance imaging (MRI) revealed a hypervascular tumor of the entire L3 vertebral body and the surrounding tissue with subtotal compression of the spinal canal (Enneking stage 3). After decompression and spinal stabilization a complete recovery of the paraparesis was seen. Two weeks after the initial presentation a recurrence of the paraparesis was noted. The subsequent MRI demonstrated a recurrent increase in the tumor size with spinal canal compression. After endovascular embolization, a gross total tumor resection with a vertebral replacement was performed. The patient was noted to have a complete recovery. Conclusion The number of cases with aggressive vertebral hemangiomas (Enneking Stage 3) is limited. However, despite limited treatment algorithms for these rare cases due to the lack of data, surgical treatment should be recommended, especially in the presence of neurological symptoms. That can be underlined by our institutional experience.

Atypical Radiographic Presentation of Aggressive Vertebral Haemangioma: Experience of Two Cases

Atypical Radiographic Presentation of Aggressive Vertebral Haemangioma: Experience of Two Cases

Aggressive vertebral hemangiomas in asymptomatic patients: A review.

Background: Hemangioma is the most common benign tumor of the spine. Most patients are asymptomatic, but some lesions can become aggressive, leading to spinal compression. Here, we reviewed the natural history and treatment of aggressive hemangiomas in asymptomatic patients.Methods: An electronic review of the literature was performed regarding the diagnosis/treatment modalities for asymptomatic aggressive hemangiomas of the spine utilizing the Medline (PubMed) and Google Scholar databases.Results: We selected four articles describing the diagnosis/management of four cases of aggressive, asymptomatic hemangiomas in patients averaging 11.25 ± 2.36 years of age. Three of the four patients were females, and all were followed an average of 36.5 ± 25 months. Notably, two of four patients required emergency surgery.Conclusion: There is a paucity of the literature regarding the diagnosis and optimal therapeutic management of aggressive hemangiomas in asymptomatic patients, half of whom may present with acute neurological deterioration warranting emergency surgery.

Role of Combined Vertebroplasty and Spinal Decompression in the Management of Aggressive Vertebral Hemangiomas.

Background:There are different surgical modalities designed to manage aggressive vertebral hemangioma (VH) that causes neurological symptoms. The selection of the best approach is still controversial. It is crucial to safely achieve neurological recovery with the elimination of the risk of recurrence. The combined use of surgical decompression and vertebroplasty is one of the surgical modalities that are used to manage these cases.Patients and Methods:From January 2012 to January 2019, nine patients with aggressive VH were retrospectively included in the study. All of them were operated upon using combined surgical decompression and vertebroplasty. We evaluated all the patients preoperatively, immediate postoperative, 1 month, and 12 months later. Clinical and radiological outcomes were assessed.Results:Affected spinal levels were dorsal in six cases and lumbar in three cases. There was no postoperative worsening of the preoperative neurological status. For the cases presented with sciatica, the mean VAS score has dropped from 8.33 preoperatively to 2.67 postoperatively. One month later, all of them are free from the radicular pain. For the cases presented with myelopathy, they regain their motor power in both lower limbs over a period of 4 weeks with a mean Nurick grade of 1.17. The postoperative radiological studies revealed near total occlusion of the VH with the maintenance of the vertebral body height. No clinical or radiological signs of spinal instability or recurrence are observed over the period of follow-up.Conclusions:The combined use of surgical decompression and vertebroplasty is considered a safe and effective modality in the management of aggressive VHs.

AGGRESSIVE VERTEBRAL HEMANGIOMAS – CASE SERIES AND LITERATURE REVIEW

ABSTRACT Objectives To present a series of aggressive hemangiomas of the institution, with a review of the management options described in the literature. Methods This is a retrospective survey of aggressive vertebral hemangiomas treated by the service in the last 10 years, with histological confirmation of the diagnosis and a minimum follow-up of 1 year. The case analysis and literature review were conducted with emphasis on treatment options for these injuries. Results Seven cases were found, three with pain and four with severe neurological deficits. Two patients were treated with open decompression, one with open decompression and cementation, one with open decompression and arthrodesis, one with biopsy and cementation, one with percutaneous biopsy, and one with open biopsy followed by decompression surgery. All patients underwent radiotherapy. There was a significant regression of presentation deficits, but one patient developed an irreversible deficit during treatment. There were no recurrences or late complications in the follow-up period. Conclusions Surgical decompression in patients with significant neurological deficit is a point of consensus in the literature. Subtotal resection followed by radiation therapy was effective in treating deficits and controlling pathology. Cases manifesting pain only can be managed with minimally invasive techniques, whether or not they are followed by radiotherapy. Level of evidence IV; Therapeutic study of case series.

Long-Term Outcomes of Excision Surgery for Aggressive Vertebral Hemangiomas

We describe the clinical outcomes in patients with aggressive vertebral hemangiomas (AVHs) after total tumor excision and discuss the treatment options for AVHs. A retrospective data review of 15 patients (6 men, 9 women) with AVHs who underwent total excision between 1996 and 2018 was performed. In total, 13 thoracic and 2 lumbar lesions were involved with 8 type A-D tumors and 7 type B-D tumors based on the Weinstein-Boriani-Biagini classification. All tumors showed low or low-iso signal intensity by T1-weighted magnetic resonance imaging. All patients received a combination of preoperative transarterial embolization and total tumor excision including the tumor margins. Eleven patients underwent total tumor excision as the initial surgery (total en bloc spondylectomy= 10 patients, piecemeal total tumor excision= 1 patient), and 4 underwent it as either a revision procedure 2 weeks after ineffective laminectomy or in the long-term follow-up (4-14 years) as a piecemeal total tumor excision. Intraoperative blood loss ranged from 150 to 3400 mL (mean, 1314 mL). None of the cases had a recurrence during the mean follow-up period of 128.4 ± 88.6 months. Low signal intensity on T1-weighted magnetic resonance imaging was observed in all the patients with AVHs. The long-term clinical results of the preoperative transarterial embolization and total tumor excision were satisfactory. The effect of decompressive incomplete tumor excision is temporary for AVHs, and repeated tumor excision may be necessary because of tumor recurrence in the long term. Reliable total tumor excision during the initial surgery is desirable.

Surgical treatment of lumbar canal stenosis with concomitant aggressive vertebral haemangioma

&lt;p&gt;Vertebral hemangiomas are the most common benign spinal tumours which are asymptomatic, slow-growing benign vascular malformations. They usually involve the vertebral body. However, the involvement of the posterior elements may present with spinal cord compression. Vertebral hemangiomas exist as a continuum of manifestations and lesions ranging from the common asymptomatic forms to rare compressive lesions. Presence of multilevel spinal canal stenosis along with an atypical vertebral hemangioma with cord is a rare condition and represents a treatment challenge. We report a case of spinal canal stenosis at L2 to L4 spinal levels along with an atypical vertebral hemangioma at L3 vertebra with extension to bilateral pedicles. This tumour caused neurological manifestations and was surgically treated with posterior decompression and stabilization with transpedicular screws and rods along with vertebroplasty for the hemangioma. Presence of an atypical hemangioma with co-existing spinal canal stenosis is a rare indication of spinal fusion. Vertebroplasty for the treatment of hemangioma in such cases is imperative.&lt;/p&gt;

Aggressive Thoracic Hemangioma Leading to Secondary Kyphosis with Paraparesis in the Postpartum Period. A Case Report

Aggressive vertebral hemangioma is rare, and its management can be very challenging. In this report, we present the case of a 30-year-old female with a normal twin pregnancy. She had been complaining of midthoracic pain after the seventh month of pregnancy with no other symptoms. Normal delivery was done under spinal anesthesia, but the patient's back pain worsened after the delivery, and she left the hospital on Day 4 with the onset of an unsteady gait. She was seen in the spinal clinic on Day 14, referred by her gynecologist, with a paraparetic presentation that was rapidly worsening. Urgent magnetic resonance imaging (MRI) was done and revealed aggressive hemangioma of T6 with kyphosis and significant cord compression. The patient was admitted and was operated the following morning. Posterior decompression with fixation from T4 to T8 and kyphosis correction was done. Samples from the vertebrae were sent to the lab for pathology analysis, and the results confirmed the diagnosis of vertebral hemangioma. She could walk on Day 1 with progressive neurological recovery, but distal junctional kyphosis in the form of a "chance fracture" of T8 occurred at 2 months and was treated conservatively. She showed a satisfactory clinical and radiological result at 2 years with no recurrence. Literature is sparse on the management of vertebral hemangioma in the context of pregnancy and postpartum, with only case reports, and its presentation as a kyphotic fracture is extremely rare. The current case shows how, in the context of delivery, a benign procedure such as spinal anesthesia should be done with extreme caution, as it may play a role in aggravating an undiagnosed aggressive hemangioma; rapid management after the onset of paraparetic symptoms enables a full neurological recovery, but close monitoring later on with regular MRI is mandatory for detection of any recurrence.

К вопросу об использовании баллонной кифопластики в хирургическом лечении агрессивных гемангиом позвоночника (клинические наблюдения)

Aggressive vertebral hemangiomas represent 4 % of all hemangiomas. Percutaneous vertebroplasty is typically considered as the first-line treatment option for aggressive hemangioma. The lesions that involve the entire vertebral body, extend into the cortical bone constitute 44 % of all vertebral hemangiomas. Extra-vertebral cement migration is reported to occur in 40 to 87.5 % of the cases at percutaneous vertebroplasty being less with the use of balloon kyphoplasty. There is a paucity of literature examining surgical treatment of aggressive hemangiomas with balloon kyphoplasty. We report two cases of aggressive vertebral hemangiomas involving the entire vertebral bodies treated with balloon kyphoplasty. The treatment provided good outcomes with no complications observed postoperatively.

Thoracic aggressive vertebral hemangiomas: multidisciplinary management in a hybrid room.

Vertebral hemangiomas (VH) account for 2-3% of all spinal tumors. The majority is incidentally found on radiographic studies: 1% present with pain and/or neurologic deficits. We report our experience with the multidisciplinary management of aggressive symptomatic thoracic VH by concomitant intraoperative sclerotization with sodium tetradecyl sulfate (STS), vertebroplasty, posterior decompression (with/without fusion) and surgical resection in a hybrid operating room (HR) equipped with a rotational scanner and a radiolucent operating table. Patients admitted with aggressive spinal VH between 2007 and 2018 were included. Data regarding demographics, presenting symptoms, location of the lesion, preoperative embolization, length of the surgery, estimated blood loss (EBL) as well as follow-up (FU) were retrieved. Five patients were included (three females, mean age 65years; range 59-75). Three patients presented with a myelopathy and two mechanical thoracic pain. All patients underwent a single-stage percutaneous sclerotization and vertebroplasty followed by a surgical decompression associated with epidural intralesional injection of STS and subtotal resection of the epidural lesion. Two patients had preoperative embolization. Mean procedural duration was 338min (range 210-480min). Four patients had marginal EBL, one patient had 500ml EBL. Patients had no evidence of lesion recurrence or progression at the end of the follow-up. The single-stage multimodal management of aggressive symptomatic VH is safe and effective. It allows for a direct intraoperative sclerotherapy combined with maximal tumor resection, resulting in reduced blood loss. The use of STS as a direct intraoperative sclerotizing agent is safe and reliable.

Current view on vertebral hemangioma

An analytical review of publications devoted to various aspects of vertebral hemangioma was conducted from following electronic databases: Scopus, Web of Science, MedLine, The Cochrane Central Register of Controlled Trials, ScienceDirect, PubMed, and elibrary, CyberLeninka. The review contains actual data on the frequency of its occurrence, the possible causes of appearance and variants of development. The issues of diagnosis of vertebral hemangioma are considered in the historical context: clinical manifestations, objective modern sur- vey methods. Special attention is paid to the morphological and pathogenetic criteria for changes in the verte- bra. It is connected with the fact, that the diagnosis vertebra hemangioma prior to the morphological study is more a collective concept than a definitive diagnosis. It is noted that the modern concept of therapeutic tac- tics is based on the nature of course of vertebral hemangioma: aggressive and non-aggressive forms. The article presents the criteria for its aggressiveness according to domestic and foreign authors. The main methods of treating neoplasm are presented: radiation therapy, alcoholization, puncture embolization of tumor vessels, puncture vertebroplasty, stenthoplasty, open interventions. In the conclusion of the review, it is emphasized that if medical tactics in case of aggressive vertebral hemangiomas are actively developed by scientific researchers, today studies on sufficient clinical material with the long-term analysis of differentiated application of physio- therapeutic treatment of the patients with vertebral pain syndromes in combination with non-aggressive vertebral hemangioma do not exist.

Intraoperative injection of absorbable gelatin sponge (AGS) mixed with cement followed by spinal decompression to treat elderly with vertebral hemangiomas

BackgroundElderly patients with vertebral hemangiomas are rare and might require surgery. Thus, the choice of surgery for these lesions remains controversial because of the rarity of these lesions. This study aimed to analyze the clinical efficacy of the intraoperative injection of absorbable gelatin sponge mixed with cement followed by spinal decompression to treat the elderly with typical vertebral hemangiomas. The risk factors for hemangioma recurrence were investigated through a literature review.MethodsWe retrospectively analyzed 13 patients with typical aggressive hemangiomas between January 2009 and January 2016. Of these patients, 7 were treated with spinal decompression combined with intraoperative vertebroplasty (Group A), and 6 patients were treated with decompression with intraoperative vertebroplasty and absorbable gelatin sponge (Group B). The general data and perioperative data of the patients were compared. Patients were followed up for at least 3 years, and postoperative complications and recurrence rates were recorded and compared.ResultsAll patients had typical aggressive hemangiomas. The average age of all patients was 64.4 ± 3.3 years. The preoperative data did not differ significantly between the two groups (P > 0.05). The blood loss of groups A and B was 707.1 ± 109.7 ml and 416.7 ± 103.3 ml, respectively (P = 0.003) (P = 0.003), and the average surgery durations were 222 ± 47.8 min and 162 ± 30.2 min, respectively (P = 0.022). The average follow-up duration was 62 ± 19 months, and no cases of recurrence were found at the final follow-up assessment.ConclusionsMultimodal treatment significantly alleviated the clinical symptoms of elderly patients with typical aggressive vertebral hemangiomas. Intraoperative absorbable gelatin sponge injection is a safe and effective way to reduce blood loss and surgery duration.