Neurological manifestations in haemangioma of the vertebrae.

Haemangioma of the vertebrae is believed to be extremely rare and of little clinical importance, because most often it is detected as an incidental radiological finding in patients examined for complaints thought to be related to other diseases. However, haemangiomata of the vertebrae have been found on examination in large necropsy series in a much larger proportion than suggested by clinical experience. Topfer (1928), in Schmorl's Institute, reported an incidence of haemangioma of 119% in a study of 2,154 spinal columns and later Junghanns (1932) found this lesion in 10% of 10,000 necropsies. Since Perman (1926) emphasized the radiological features characteristic of haemangioma of the vertebrae, there has been increasing interest in this lesion, particularly when it was realized that it may be responsible for a wide variety of symptoms and signs ranging from tenderness and mild pain over the diseased vertebrae to complete transverse myelopathy. Furthermore, neurological disturbances occur more frequently in association with haemangioma of the vertebrae than appears from the literature, and since we started performing systematic radiological examinations in patients referred to our out-patient clinic for back pain we found haemangioma of the vertebrae in a comparatively short time in another three patients who were not admitted to hospital. The indications for surgical treatment of patients with signs of cord compression are still a. matter of dispute. Opinion has been divided ever since Nattrass and Ramage (1932) and Ferber and Lampe (1942) insisted that radiotherapy only should be used in all cases of vertebral haemangioma. We therefore present eight cases of haemangioma of the vertebrae seen during the last few years in the Department of Neurosurgery of the Beilinson Hospital. The salient features of these patients are summarized in Table I. Our patients experienced various back, shoulder, arm, chest, abdominal, and sciatic pains. Some were thought to have cardiac, joint, or abdominal disease. Others exhibited neurological disturbances.