Management of painful vertebral hemangiomas with kyphoplasty: A report of two cases and a literature review

Background and Objectives: Although uncommon, symptomatic vertebral hemangiomas can be a painful condition limiting daily activities. Balloon kyphoplasty is a developing technique that has successfully been used in the treatment of vertebral hemangiomas as reported in a few publications. The aim of this paper is to describe 2 cases of painful vertebral hemangiomas effectively treated with percutaneous balloon kyphoplasty and review the current literature. Design and Methods: A 38-year-old male with a painful L5 biopsy-proven hemangioma and a 75-year-old female with a painful T12, hemangioma MRIproven both presented with thoraco-lumbar pain. Physical exams correlated with imaging findings and no neurological symptoms were present. Both patients received conservative management including physical therapy and a variety of spinal injections without benefit. Percutaneous balloon kyphoplasty was subsequently performed on each patient to relieve pain. Results: After kyphoplasty, both patients' pain resolved immediately and they were able to resume previous levels of activity. Conclusions: This case series demonstrates a successful response to vertebral augmentation using balloon kyphoplasty when other treatment modalities failed. When compared to traditional first line treatments such as vertebroplasty or lytic therapies, kyphoplasty may offer fewer procedural risks such as a decreased exposure to radiation, a decreased risk of excessive hemorrhage, and a decreased risk of cement leakage which may make it the preferred treatment of painful vertebral hemangiomas in the future.