Decompression surgery with intraoperative vertebroplasty: A reduced invasiveness treatment strategy for aggressive vertebral hemangiomas

Purpose Aggressive vertebral hemangiomas (VHs) are rare benign tumors but can cause neurological deficits. Currently, the optimal treatment strategy for aggressive VHs remains controversial. The purpose of study is to evaluate the safety and efficacy of decompression surgery with intraoperative vertebroplasty for the treatment of aggressive VHs. Methods A total of 85 aggressive VH patients with neurological deficits who underwent decompression surgery with intraoperative vertebroplasty between January 2010 and May 2024 were included in this study. Clinical data such as patient demographics, symptoms, neurological function, pain levels, radiologic features, surgical information, pathology, and perioperative complications, were recorded and analyzed. Enneking staging was determined based on radiological findings. Neurological function and pain levels were assessed using the Frankel grade and the Visual Analogue Scale (VAS), respectively. The minimum follow-up duration was 12 months. Results The average age of 85 patients (49 male and 36 female) was 51.1 ± 14.3 (21–77) years. Lesions were located in the cervical spine in 1 case, the thoracic spine in 67 cases, and the lumbar spine in 17 cases. All surgery procedures were completed successfully with an average surgery duration of 168.2 ± 83.3 (90–500) minutes and an average blood loss of 670.1 ± 674.8 (50–2500) ml. Preoperative embolization significantly reduced intraoperative blood loss (P < 0.01). Postoperatively, the pain levels of patients were significantly alleviated (P < 0.01). The average follow-up duration was 76.1 ± 55.1 (12–182) months and all patients remained alive at the final follow-up. Recurrence was observed in eight patients, one of whom underwent surgery combined with radiotherapy, while the remaining seven received radiotherapy alone, and at the last follow-up, these patients were symptom-free. Adequate and satisfactory intraoperative filling of bone cement could reduce the risk of recurrence (P < 0.01). Conclusions Decompression surgery with intraoperative vertebroplasty can effectively reduce blood loss, alleviate neurological symptoms and reduce the risk of recurrence, and is a safe and effective approach in the management of aggressive VHs.