Vertebral Hemangioma
A vertebral hemangioma is a benign vascular lesion made up of abnormal blood vessels within a vertebra, the bony building block of the spine. Vertebral hemangiomas are extremely common and are most often discovered incidentally on MRI or CT scans performed for unrelated reasons. The vast majority cause no symptoms and require no treatment. In rare cases, larger or more aggressive hemangiomas can produce back pain or compress nearby nerves or the spinal cord.
What is it?
A vertebral hemangioma is a non-cancerous vascular lesion formed by abnormal blood vessels inside the vertebral bone. These lesions develop slowly over time and most commonly occur within the vertebral body, although they may occasionally extend into the posterior elements or epidural space.
Vertebral hemangiomas are among the most common incidental findings on spine imaging and are not related to metastatic cancer or infection.
Most vertebral hemangiomas remain stable throughout life and never cause symptoms. On imaging, they often demonstrate highly characteristic appearances that allow confident diagnosis. CT may show a classic “polka-dot” or “corduroy” pattern created by thickened bony trabeculae interspersed with vascular channels.
The thoracic spine is the most frequently affected region, followed by the lumbar spine, although hemangiomas can occur anywhere along the spine.
Most lesions are solitary, but multiple vertebral hemangiomas can occur.
Vertebral hemangiomas are commonly divided into typical and atypical forms based on imaging appearance.
Typical hemangiomas contain a large amount of fat and usually remain inactive and asymptomatic.
Atypical or aggressive hemangiomas contain less fat and more vascular tissue and may demonstrate expansion of the vertebra, extension into surrounding tissues, or compression of nearby nerves or the spinal cord. These aggressive forms are rare.
Symptoms, when present, may include localized back pain, stiffness, numbness, weakness, gait imbalance, or radiating pain if the lesion contributes to spinal canal narrowing or nerve compression.
MRI of the spine is the preferred imaging test for evaluating vertebral hemangiomas because it provides detailed assessment of the lesion, spinal cord, nerves, and surrounding soft tissues.
Typical hemangiomas often appear bright on both T1- and T2-weighted MRI sequences because of their fatty content. More aggressive lesions may have a less typical appearance and occasionally require additional imaging evaluation.
CT is especially useful for evaluating the bony architecture and confirming characteristic trabecular patterns within the lesion.
Additional imaging such as MRI with contrast, vascular imaging, or follow-up studies may be used when aggressive behavior or an alternative diagnosis is being considered.
Important to Know
The vast majority of vertebral hemangiomas are harmless incidental findings that require no treatment or follow-up.
When back pain is present, it is often caused by more common spinal conditions such as degenerative disc disease, facet arthropathy, spinal stenosis, or muscular strain rather than by the hemangioma itself.
In the uncommon situation where a vertebral hemangioma causes symptoms or demonstrates aggressive imaging features, treatment options may include vertebroplasty, embolization, radiation therapy, surgical decompression, or spinal stabilization procedures.
Treatment decisions are individualized and depend on lesion size, location, degree of spinal cord or nerve compression, symptoms, and overall spinal stability.
Because atypical vertebral hemangiomas can occasionally resemble metastatic disease or other bone lesions on imaging, careful interpretation by a radiologist is important.
Imaging findings are always interpreted together with symptoms, neurological examination findings, and the broader clinical picture.
Red flag symptoms include sudden severe back pain, progressive weakness or numbness, gait or balance difficulty, loss of bowel or bladder control, or new pain following trauma. These symptoms require prompt medical evaluation because they may indicate spinal cord compression or another serious spinal condition.