Chiropractic Management of Symptomatic Pedicle Hemangioma: a Case Report

Abstract

Spinal hemangiomas are the most commonly encountered primary vertebral tumors, which are benign and asymptomatic. They usually occur in the vertebral body and rarely extend into or originate from the posterior column. Thus, hemangiomas of the pedicle are extremely rare. Only one case of pedicle hemangioma has been documented in the literature. Disc herniations and annular tears are not always symptomatic, and they have always been observed in asymptomatic patients. Therefore, even with a thorough medical history and physical examination, patients with comorbid hemangioma and annular tears present a formidable challenge to the most experienced clinicians. This report describes a rare case of pedicle hemangioma and disc herniation without spinal cord compression in a 47-year-old woman complaining of lower back pain and inability to walk.

FIGURE 1.

No vertebral collapse, significant marginal osteophyte, and osseous erosion were observed. At the left L5 pedicle, a T1 and T2 hyperintense 13.3 × 10 mm osseous lesion that was not associated with any adjacent marrow edema or cortical disruption can be observed (red arrow)

FIGURE 2.

At the L5/S1, the disc is desiccated. It is associated with a focal posterocentral disc protrusion (red arrow), and anterior–posterior and lateral dimensions of the central spinal canal are not narrowed. No foraminal stenosis was observed (a). The disc herniation did not cause any compression onto the thecal sac or the descending S1 roots. However, it was associated with an anulus tear. Contour of the thecal sac was smooth (b)