research articles on pain management

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Pain management articles from across Nature Portfolio

Pain management refers to a therapy that is directed at ameliorating pain and suffering and improving health-related quality of life in patients with pain. It includes analgaesic, anxiolytic and non-pharmacological treatments.

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Effect of pacifier and pacifier with dextrose in reducing pain during orogastric tube insertion in newborns: a randomized controlled trial*

• Ayşenur Akkaya-Gül
• Nurcan Özyazıcıoğlu

Association of long-term use of non-steroidal anti-inflammatory drugs with knee osteoarthritis: a prospective multi-cohort study over 4-to-5 years

• Zubeyir Salis
• Amanda Sainsbury

Effect of monopolar diathermy power settings on postoperative pain, wound healing, and tissue damage after tonsillectomy: a randomized clinical trial

• Ju Hyun Yun
• Jeon Yeob Jang
• Do-Yang Park

The potential of a multimodal digital care program in addressing healthcare inequities in musculoskeletal pain management

• Anabela C. Areias
• Maria Molinos
• Fabíola Costa

Evaluation of paravertebral blocks in improving post-procedural pain and decreasing hospital admission after microwave ablation of liver tumors

• Nicholos Joseph
• Virginia H. Sun
• Rafael Vazquez

Immediate systemic neuroimmune responses following spinal mobilisation and manipulation in people with non-specific neck pain: a randomised placebo-controlled trial

• Ivo J. Lutke Schipholt
• Michel W. Coppieters
• Gwendolyne G. M. Scholten-Peeters

News and Comment

Which nsaids are best for oa treatment.

• Sarah Onuora

Topical NSAIDs come out top for knee OA

• Joanna Clarke

Going for gold to improve anti-NGF therapy in OA

Photothermal therapy using gold nanorods targeted to nerve growth factor shows promise for relieving pain in a mouse model of osteoarthritis.

Improving care to decrease stone recurrence and opioid use

In 2019, quality improvement has been a central theme throughout leading articles on nephrolithiasis. Real-world outcomes were published on the natural history of stones and residual fragments, patient compliance with medical therapy and treatment-related opioid use. In-depth review of these topics will enhance provider–patient counselling and shape future paradigms in stone disease.

• Jonathan G. Pavlinec
• Benjamin K. Canales

Can personalized use of NSAIDs be a reality in the clinic?

The use of NSAIDs in rheumatology could be improved by an appropriate risk scoring system that accounts for adverse events such as bleeding and thrombosis. Such a risk score has now been developed using data from the PRECISION trial, but is this score ready to be applied in clinical practice?

• Michael T. Nurmohamed

NGF vaccine reduces pain

• Nicholas J. Bernard

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Pain Management

Articles (18 in this collection), the difficulties of managing pain in people living with frailty: the potential for digital phenotyping, authors (first, second and last of 11).

• Jemima T. Collins
• David A. Walsh
• Wilco Achterberg
• Content type: Leading Article
• Open Access
• Published: 24 February 2024
• Pages: 199 - 208

NSAIDs for Pain Control During the Peri-Operative Period of Hip Fracture Surgery: A Systematic Review

Authors (first, second and last of 12).

• Wilhelm Pommier
• Elise-Marie Minoc
• Cédric Villain
• Content type: Systematic Review
• Published: 25 October 2023
• Pages: 125 - 139

Evaluation and Treatment of Acute Trauma Pain in Older Adults

Authors (first, second and last of 4).

• Minnie Merrick
• Robert Grange
• David Shipway
• Content type: Current Opinion
• Published: 11 August 2023
• Pages: 869 - 880

Intranasal Dexmedetomidine for Pain Management in Older Patients: A Cross-Over, Randomized, Double-Blinded, Active-Controlled Trial

Authors (first, second and last of 6).

• Nathalie Dieudonné Rahm
• Isabelle Zaccaria
• Content type: Original Research Article
• Published: 11 May 2023
• Pages: 527 - 538

Correlates of Opioid Use Among Ontario Long-Term Care Residents and Variation by Pain Frequency and Intensity: A Cross-sectional Analysis

Authors (first, second and last of 17).

• Anita Iacono
• Michael A. Campitelli
• Colleen J. Maxwell
• Published: 17 August 2022
• Pages: 811 - 827

Pain Management in Older Adults with Chronic Wounds

• Michal Dubský
• Vladimira Fejfarova
• Edward B. Jude
• Content type: Review Article
• Published: 13 July 2022
• Pages: 619 - 629

Pharmacotherapy for Spine-Related Pain in Older Adults

• Jonathan L. Fu
• Michael D. Perloff
• Published: 27 June 2022
• Pages: 523 - 550

Postoperative Pain Treatment in Patients with Dementia: A Retrospective Observational Study

• Nobuo Sakata
• Yasuyuki Okumura
• Published: 01 April 2022
• Pages: 305 - 311

Pharmacological Pain Treatment in 2012 and 2017 Among Older People with Major Neurocognitive Disorder

• Maria Gustafsson
• Hugo Lövheim
• Maria Sjölander
• Published: 19 October 2021
• Pages: 1017 - 1023

Diagnostic and Management Strategies for Patients with Chronic Prostatitis and Chronic Pelvic Pain Syndrome

Authors (first, second and last of 5).

• Vanessa N. Pena
• Amin S. Herati
• Published: 29 September 2021
• Pages: 845 - 886

Prevalence of Musculoskeletal Pain and Analgesic Treatment Among Community-Dwelling Older Adults: Changes from 1999 to 2019

• Tuuli Elina Lehti
• M.-O. Rinkinen
• K. H. Pitkälä
• Published: 13 August 2021
• Pages: 931 - 937

Diagnosis and Management of Pain in Parkinson's Disease: A New Approach

• Veit Mylius
• Jens Carsten Möller
• Santiago Perez Lloret
• Published: 05 July 2021
• Pages: 559 - 577

Risk of Fractures in Older Adults with Chronic Non-cancer Pain Receiving Concurrent Benzodiazepines and Opioids: A Nested Case–Control Study

Authors (first, second and last of 7).

• Ye-Jin Kang
• Min-Taek Lee
• Sun-Young Jung
• Published: 23 June 2021
• Pages: 687 - 695

Feasibility of Intranasal Dexmedetomidine in Treatment of Postoperative Restlessness, Agitation, and Pain in Geriatric Orthopedic Patients

• Panu Uusalo
• Suvi-Maria Seppänen
• Mikko J. Järvisalo
• Published: 16 March 2021
• Pages: 441 - 450

Priority-Setting to Address the Geriatric Pharmacoparadox for Pain Management: A Nursing Home Stakeholder Delphi Study

• Kate L. Lapane
• Catherine Dubé
• Dmitry Khodyakov
• Published: 24 February 2021
• Pages: 327 - 340

Managing Interstitial Cystitis/Bladder Pain Syndrome in Older Adults

• Alyssa Gracely
• Anne P. Cameron
• Published: 23 October 2020
• Pages: 1 - 16

Chronic Post-Surgical Pain in the Frail Older Adult

• Stacie Deiner
• Yury Khelemsky
• Published: 16 April 2020
• Pages: 321 - 329

Topical Treatment of Localized Neuropathic Pain in the Elderly

• Gisèle Pickering
• Camille Lucchini
• Published: 09 January 2020
• Pages: 83 - 89

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Pain Management in Pediatric Burns: A Review of the Science behind It

Affiliations.

• 1 Department of Paediatric Surgery and Orthopedics, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.
• 2 Department of Pediatric Surgery, "Louis Turcanu" Emergency Children's Hospital, Timisoara, Romania.
• PMID: 37745034
• PMCID: PMC10516692
• DOI: 10.1155/2023/9950870

Pediatric burns are a significant medical issue that can have long-term effects on various aspects of a child's health and well-being. Pain management in pediatric burns is a crucial aspect of treatment to ensure the comfort and well-being of young patients. The causes and risk factors for pediatric burns vary depending on various factors, such as geographical location, socioeconomic status, and cultural practices. Assessing pain in pediatric patients, especially during burn injury treatment, poses several challenges. These challenges stem from various factors, including the age and developmental stage of the child, the nature of burn injuries, and the limitations of pain assessment tools. In pediatric pain management, various pain assessment tools and scales are used to evaluate and measure pain in children. These tools are designed to account for the unique challenges of assessing pain in pediatric patients, including their age, developmental stage, and ability to communicate effectively. Pain can have significant physical, emotional, and psychological consequences for pediatric patients. It can interfere with their ability to engage in daily activities, disrupt sleep patterns, and negatively affect their mood and behavior. Untreated pain can also lead to increased stress, anxiety, and fear, which can further exacerbate the pain experience. Acute pain, which is short-term and typically associated with injury or illness, can disrupt a child's ability to engage in physical activities and impede their overall recovery process. On the other hand, chronic pain, which persists for an extended period, can have long-lasting effects on physical functioning and quality of life in children. The psychological consequences of burns can persist long after the physical wounds have healed, leading to ongoing emotional distress and impaired functioning. Multimodal pain management, which involves the use of multiple interventions or medications targeting different aspects of the pain pathway, has gained recognition as an effective approach for managing pain in both children and adults. However, it is important to consider the specific needs and considerations of pediatric patients when developing evidence-based guidelines for multimodal pain management in this population. Over the years, there have been significant advances in pediatric pain research and technology, leading to a better understanding of pain mechanisms and the development of innovative approaches to assess and treat pain in children. Overall, pain management in pediatric burns requires a multidisciplinary approach that combines pharmacologic and nonpharmacologic interventions.

Copyright © 2023 Bogdan Ciornei et al.

Publication types

• Acute Pain*
• Burns* / complications
• Burns* / therapy
• Chronic Pain*
• Pain Management
• Quality of Life

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Trends and Factors Associated With Pediatric Opioid Use in Emergency Departments

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Mohamed Eltorki , Eman Rezk , Wael El-Dakhakhni , Stephen B. Freedman , Amy Drendal , Samina Ali; Trends and Factors Associated With Pediatric Opioid Use in Emergency Departments. Pediatrics June 2024; 153 (6): e2023065614. 10.1542/peds.2023-065614

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In the 1990s, campaigns promoting the use of opioids for pain management led to a dramatic increase in use and contributed to the current opioid crisis. 1   In response, opioid prescribing stewardship initiatives have attempted to reduce unnecessary usage. 2   – 6   Notably, clinician decision-making to use opioids in emergency departments (EDs) is associated with factors including race, sex, condition and payor. 7   In this brief research report, we use the National Hospital Ambulatory Medical Care Survey (NHAMCS) 8   data to update a prior analysis (2006–2015) 9   and examine shifts in opioid use for pediatric pain management in US EDs from 2011 to 2020.

We analyzed NHAMCS data from January 1, 2011, to December 31, 2020, for children ≤18 years. Annual data released by the National Center for Health Statistics were used, with abstracted visit records using a computerized survey instrument, and surveys are weighted using population statistics to estimate national visits. The study, which followed STROBE guidelines, was approved by the National Center for Health Statistics Research Ethics Board and was exempt from local ethics review.

Our analysis included all children grouped by age into 3 developmental stages: <6 years, 6 to <12 years, and 12 to ≤18 years. Incorporating existing knowledge, 9   we followed a time lapse analysis with an extension to encompass data from 2016 to 2020. This 5-year segmentation aligns our approach with prior research 9   while ensuring a sufficiently robust dataset for precise estimations. Additionally, we focused only on definitively painful conditions using a validated classification methodology (see Supplement). 10  

Our primary outcome measure was treatment with any opioid during the ED visit. Covariates included race, ethnicity, age group, sex, ambulance arrival, payor, geographic region, triage category, pain level, type of painful condition, and the 5-year time lapse intervals. Analysis employed SPSS complex samples package, considering NHAMCS sampling design, with multivariate logistic regression for odds ratios and 95% confidence intervals.

During the study period, there were 321 million pediatric US ED visits (unweighted count 51 434) among which 156 million visits had a definitive painful condition (unweighted sample 24 816); 11.32 million were administered ≥1 opioid in the ED (unweighted count 1895) ( Table 1 ). There was a 48% relative reduction in opioid administration, dropping from 14.5% (10.9–19.0) in 2011 to 7.5% (5.0–10.9) in 2020 among ED visits with definitive pain ( Fig 1 ). Despite an increase of 1.62 million ED visits for definitive painful conditions from 2016 to 2020 compared with 2011 to 2015, opioid administration decreased from 8.6% (8.0–9.2) to 6.0% (5.1–7.0), a difference of 2.6% (2.5–2.7) among ED visits with definitive pain.

Trends in opioid administration for acute pain in US emergency departments, 2011 to 2020.

Baseline Characteristics of All Pediatric Visits With Definitive Pain Condition From 2011 to 2020

ENT, ear, nose, and throat; MSK, musculoskeletal.

Asian, Native Hawaiian, American Indian/Alaska Native and if more than once race is reported.

Pain scale has 2 more categories blank and unknown.

Non-MSK injuries (lacerations, contusions, bruises).

Pain unspecified, stiffness site unspecified, nonspecified pain, ache or soreness in any site, postsurgical pain.

In our regression model, males were more likely to receive opioids, as were those aged ≥12 compared with <6 years. Black children were less likely to receive opioids compared with white children (adjusted odds ratio 0.69 [0.58–0.84]). Other factors that were associated with opioid administration included payor, method of arrival, US geographic location, and triage level ( Table 2 ). The likelihood of opioid administration escalated with each pain severity level ≥ discomforting pain, with the highest for unbearable pain compared with no pain (adjusted odds ratio 8.17 [6.89–9.46]). The administration of opioids to children with definitive pain in the ED was 39% lower among patients who sought ED care between 2016 and 2020 compared with those who sought care from 2011 to 2015. Conditions associated with opioid use include burns and fractures, whereas those associated with nonopioids included chest, headache, and nonmusculoskeletal injuries.

Logistic Regression Analysis for Opioid Prescription for Patients With Definitive Pain (2011–2020)

We found a clinically important reduction in the proportion of children who received an opioid from 14.5% in 2010 to 6% in 2020. Although opioid use was demonstrated to be decreasing over the study timeframe, a race-based gap persists, with White children having 31% higher odds of receiving opioids than Black children. This finding merits further exploration to understand the practice pattern variation and socio-demographic characteristics that may influence this observation but are beyond the scope of this study. Our study is constrained by its retrospective design and relies on the precision and reliability of the NHAMCS dataset, which was built to portray disease epidemiology and treatments but lacks sufficient detail to control for severity of illness. To avoid missing data, we used the imputed NHAMCS variable that only has three race categories (white-, Black- and other-children), making it challenging to provide detailed insights into individual racial groups. Our findings highlight the need for further research to determine which nonopioid analgesic might be appropriate for specific definitively painful presentations in children and why disparities continue to exist in relation to sex, age, and race.

Drs Eltorki and Rezk conceptualized and designed the study, conducted the analysis, and drafted the initial manuscript; Dr El-Dakhakhni supervised the data structuring and analysis; Dr Ali supervised the study, reviewed categorization of painful conditions and analgesics included in the analysis, and reviewed the initial analysis; Drs Drendal and Freedman provided input in analysis; and all authors critically reviewed and revised the manuscript, approved the final manuscript as submitted, and agree to be accountable for all aspects of the work.

FUNDING: No external funding.

CONFLICT OF INTEREST DISCLOSURES: The authors have no known conflicts of interest relevant to this article to disclose.

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• Published: 24 May 2024

Vertebral hemangiomas: a review on diagnosis and management

• Kyle Kato 1 ,
• Nahom Teferi 2 ,
• Meron Challa 1 ,
• Kathryn Eschbacher 3 &
• Satoshi Yamaguchi 2  

Journal of Orthopaedic Surgery and Research volume  19 , Article number:  310 ( 2024 ) Cite this article

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Vertebral hemangiomas (VHs) are the most common benign tumors of the spinal column and are often encountered incidentally during routine spinal imaging.

A retrospective review of the inpatient and outpatient hospital records at our institution was performed for the diagnosis of VHs from January 2005 to September 2023. Search filters included “vertebral hemangioma,” "back pain,” “weakness,” “radiculopathy,” and “focal neurological deficits.” Radiographic evaluation of these patients included plain X-rays, CT, and MRI. Following confirmation of a diagnosis of VH, these images were used to generate the figures used in this manuscript. Moreover, an extensive literature search was conducted using PubMed for the literature review portion of the manuscript.

VHs are benign vascular proliferations that cause remodeling of bony trabeculae in the vertebral body of the spinal column. Horizontal trabeculae deteriorate leading to thickening of vertical trabeculae which causes a striated appearance on sagittal magnetic resonance imaging (MRI) and computed tomography (CT), “Corduroy sign,” and a punctuated appearance on axial imaging, “Polka dot sign.” These findings are seen in “typical vertebral hemangiomas” due to a low vascular-to-fat ratio of the lesion. Contrarily, atypical vertebral hemangiomas may or may not demonstrate the “Corduroy” or “Polka-dot” signs due to lower amounts of fat and a higher vascular component. Atypical vertebral hemangiomas often mimic other neoplastic pathologies, making diagnosis challenging. Although most VHs are asymptomatic, aggressive vertebral hemangiomas can present with neurologic sequelae such as myelopathy and radiculopathy due to nerve root and/or spinal cord compression. Asymptomatic vertebral hemangiomas do not require therapy, and there are many treatment options for vertebral hemangiomas causing pain, radiculopathy, and/or myelopathy. Surgery (corpectomy, laminectomy), percutaneous techniques (vertebroplasty, sclerotherapy, embolization), and radiotherapy can be used in combination or isolation as appropriate. Specific treatment options depend on the lesion's size/location and the extent of neural element compression. There is no consensus on the optimal treatment plan for symptomatic vertebral hemangioma patients, although management algorithms have been proposed.

While typical vertebral hemangioma diagnosis is relatively straightforward, the differential diagnosis is broad for atypical and aggressive lesions. There is an ongoing debate as to the best approach for managing symptomatic cases, however, surgical resection is often considered first line treatment for patients with neurologic deficit.

Introduction

Vertebral hemangiomas (VHs) are benign vascular lesions formed from vascular proliferation in bone marrow spaces that are limited by bony trabeculae [ 1 ]. VHs are quite common and are often incidental findings on spinal computed tomography (CT) and magnetic resonance imaging (MRI) of patients presenting with back or neck pain [ 2 , 3 ]. Previous, large autopsy series such as Schmorl (1926) and Junghanns (1932) found a VH prevalence of 11% in adult specimens [ 1 , 4 ]. However, the prevalence is believed to be higher as modern imaging techniques allow for better detection of small VHs that may not be easily diagnosed on autopsy specimens [ 5 ]. They can occur at any age but are most often seen in individuals in their 5th decade of life with a slight female preponderance [ 2 , 6 , 7 ]. Most VHs are found in the thoracic or lumbar spinal column and often involve the vertebral body, though they can extend to the pedicle, lamina, or spinous process, and may span multiple spinal segments [ 5 ].

The vast majority of VHs are asymptomatic, quiescent lesions [ 3 ]. Prior studies have stated less than 5% of VHs are symptomatic [ 8 , 9 ], although the 2023 study by Teferi et. al. demonstrated 35% of their 75 VH patients presented with symptoms including localized pain, numbness, and/or paresthesia [ 1 ]. 85% of symptomatic cases in this series were found to have VHs localized in the thoracic spine [ 1 ].

Among symptomatic VHs, up to 20–45% of cases may exhibit aggressive features including damage to surrounding bone and soft tissue or demonstrate rapid growth that extends beyond the vertebral body and invades the paravertebral and/or epidural space [ 1 , 5 , 10 , 11 ]. When “aggressive”, VHs may compress the spinal cord and nerve roots causing severe symptoms [ 1 , 5 ]. 45% of symptomatic VH patients present with neurologic deficits secondary to compressive lesions, bony expansion, disrupted blood flow, or vertebral body collapse while the remaining 55% present solely with back pain [ 8 , 12 , 13 , 14 , 15 ].

VHs are primarily diagnosed with radiographs, CT, and MRI, although other studies such as angiography, nuclear medicine studies, and positron emission—computed tomography (PET-CT) have been previously utilized to a lesser extent [ 1 , 15 , 16 , 17 , 18 , 19 ]. Radiologically, these lesions can be grouped into Typical, Atypical, and Aggressive subtypes (see radiological features). Histologically, VHs are composed of varying proportions of adipocytes, blood vessels, and interstitial edema which leads to thickening of vertical trabeculae in the affected vertebra [ 5 ]. This histopathology leads to the characteristic “polka-dot” sign on axial CT/MRI and “corduroy” sign on coronal and sagittal CT/MRI [ 5 , 20 ].

In terms of management, conservative treatment with observation and pain control are the mainstay of treatment for asymptomatic VH patients and those with mild-to-moderate pain respectively [ 21 ]. Surgical decompression is indicated for patients with neurologic deficits including compressive myelopathy or radiculopathy [ 22 ]. Other symptomatic patients have a wide variety of treatment options available including sclerotherapy, embolization, radiotherapy, and/or vertebroplasty [ 1 , 5 , 23 ]. The best approach in managing an individual patient with a symptomatic VH has not been elucidated and there have been different management algorithms suggested based on varying institutional experiences [ 1 , 5 , 24 , 25 ].

This article will review what is currently known regarding VHs. Diagnostic techniques and challenges will be highlighted as well as current treatment recommendations from the literature.

A retrospective review of the inpatient and outpatient hospital records at our institution was performed for the diagnosis of VHs from January 2005 to September 2023. Search filters included “vertebral hemangioma” "back pain,” “weakness,” “radiculopathy,” and “focal neurological deficits.” Radiographic evaluation of these patients included plain X-rays, CT, and MRI. Following confirmation of a diagnosis of VH, these images were used to generate the figures used in this manuscript. Moreover, an extensive literature search was conducted using PubMed for the literature review portion of the manuscript.

68 Articles were selected from our PubMed search. This article will review what is currently known about VHs. Diagnostic techniques and challenges will be highlighted as well as current treatment recommendations from the literature.

Histopathological features

VHs are benign tumors composed of various sized blood vessels, adipocytes, smooth muscle, fibrous tissue, hemosiderin, interstitial edema, and remodeled bone [ 5 , 7 , 26 , 27 ]. Macroscopically, they appear as soft, well-demarcated, dark red masses with intralesional, sclerotic boney trabeculae and scattered blood-filled cavities lending to a honeycomb appearance [ 5 , 6 , 7 ].

Microscopically, there are four subtypes of hemangiomas based on vascular composition: capillary, cavernous, arteriovenous (AV), and venous hemangiomas [ 28 ] (Fig.  1 ). Capillary hemangiomas are composed of small, capillary-sized blood vessels while cavernous hemangiomas present with collections of larger, dilated blood vessels [ 1 ]. AV hemangiomas are composed of interconnected arterial and venous networks while an abnormal collection of veins comprises venous hemangiomas [ 1 ]. VHs are predominately capillary and cavernous subtypes with thin-walled blood vessels surrounded by edematous stroma and boney trabeculae that permeate the bone marrow space [ 1 , 7 , 27 ]. In a sample of 64 surgically treated VHs cases, Pastushyn et al. reported 50% were capillary subtype, 28% were cavernous subtype, and 22% were mixed [ 29 ]. Occasionally, secondary reactive phenomena such as fibrous and/or adipose involution of bone marrow and remodeling of bone trabeculae may be seen [ 7 , 26 ]. Symptomatic VHs can be caused by all hemangioma subtypes, and there are no distinguishing features between subtypes on imaging [ 1 ]. However, cavernous and capillary subtypes are associated with favorable postsurgical outcomes [ 29 ].

Capillary hemangioma ( A and B ): A H&E 200× magnification showing proliferation of small caliber vessels within a fibrous stroma with surrounding bone, B CD34 immunohistochemical stain, 200× magnification highlighting small caliber vascular spaces. Cavernous hemangioma ( C and D ): C H&E 100× magnification showing proliferation of thin-walled, dilated, blood filled vascular channels, D H&E 200× magnification: Thin-walled, dilated vascular channels within a loose stroma with adjacent mature bone. Venous hemangioma ( E and F ): E H&E 100 ×  magnification showing abnormal proliferation of thick-walled vessels with dilated lumens. F H&E 100× magnification reveals tightly packed, thick-walled vessels with adjacent fragments of mature bone

Radiographic features

The histopathology of VHs gives rise to imaging features used to classify VHs as typical, atypical, or aggressive [ 13 ]. Typical and atypical MRI findings are correlated with the intralesional ratio of fat to vascular components [ 20 ]. Lesions with a high fat content are more likely to demonstrate features of typical VHs while those with a high vascular content (atypical VHs) tend to present without these findings [ 5 , 30 , 31 ]. Aggressive VHs have features including destruction of the cortex, invasion of the epidural and paravertebral spaces, and lesions extending beyond the vertebral body [ 13 , 15 , 20 ].

Laredo et al. demonstrated that VHs with a higher fatty content are generally quiescent lesions, while those with a higher vascular content are more likely to display “active” behavior and potentially evolve into compressive lesions [ 20 ]. Therefore, asymptomatic VHs can display both typical or atypical imaging findings while symptomatic lesions are more likely to present with atypical or aggressive findings [ 1 ]. Despite radiographically typical VHs being relatively easy to diagnose, atypical and aggressive VHs are much more challenging to recognize as they do not present with classic imaging findings and often mimic other pathologies such as multiple myeloma, metastatic bone lesions, and inflammatory conditions [ 5 , 30 , 31 ]. Compressive VHs often have coinciding radiologic and clinical classifications due to the correlation between aggressive behavior and compressive symptoms [ 5 ].

While MRI, CT, and radiographs are the primary imaging modalities used in the workup of VHs, other studies have also been used. Angiography will occasionally be performed to identify feeding/draining vessels and evaluate the blood supply to the spinal cord [ 5 ]. Multiphase technetium 99-methyl diphosphonate ( 99 Tc-MDP) bone scintigraphy may show increased tracer uptake in all phases (perfusion, blood pool, and delayed) due to technetium 99-labeled red blood cell accumulation in the tumors, which occurs in all hemangiomas [ 16 ]. PET-CT has been used to classify VHs as “hot” or “cold” lesions based on the degree of 18-FDG and 68-Ga DOTATATE uptake [ 17 , 18 , 19 ]. Although angiography is useful in clarifying the vascular network of aggressive VHs primarily, nuclear medicine studies offer a much more limited contribution to diagnosis when compared to CT and MRI [ 5 ].

Typical VHs

The collection of thin-walled, blood-filled spaces that comprise VHs cause resorption of horizontal trabeculae and reinforcement of vertical trabeculae, leading to a pattern of thickened vertical trabeculae interspersed with lower density bone of the nonexpanding vertebral body [ 15 , 31 , 32 ]. This composition is responsible for the “corduroy cloth” appearance seen in typical VHs on radiographic images [ 31 ].

On unenhanced axial CT images, typical VHs are characterized by a “polka dot” appearance, termed polka-dot sign. This is caused by small, punctate areas of high attenuation from hyperdense trabeculae surrounded by hypodense stroma [ 20 , 33 ] (Fig.  2 ). Like radiographs, sagittal and coronal CT images display the “corduroy” sign caused by thickened trabeculae in a field of hypodense bone (Fig.  2 ). There is no extraosseous extension of the hemangioma in typical VHs [ 5 ].

Sagittal ( A ) and axial ( B ) CT scans of a typical VH in an asymptomatic 50-year-old male demonstrating the “Corduroy” and “Polka-dot” signs respectively. Sagittal ( C ) and axial ( D ) T1-weighted MRIs of typical VHs are predominately hyperintense with areas of hypo-intensity due to thickening of vertical trabeculae. Sagittal ( E ) and axial ( F ) T2-weighted MRIs of typical VHs also appear as hyperintense lesions with areas of hypo-intensity that may demonstrate the “Corduroy” and “Polka-dot” signs as seen in CT images of typical VHs

Typical VHs tend to appear as hyperintense lesions on T1- and T2-weighted MRI sequences due to predominately fatty overgrowth with penetrating blood vessels [ 31 ] (Fig.  2 ). There are punctate areas of slight hypointensity within the lesion on axial T1-weighted MRI due to thickened vertical trabeculae which resembles the “polka-dot" sign [ 5 ] (Fig.  2 ). These trabeculae appear as linear striations on sagittal/coronal T1- and T2-weighted MRI [ 5 ] (Fig.  2 ). Fluid-sensitive sequences (i.e. short-tau inversion recovery or fat-saturated T2-weighted MRI) appear slightly hyperintense due to the vascular components of the lesion, and T1-weighted MRI with contrast demonstrates heterogenous enhancement of the lesion [ 3 ] (Fig.  3 ).

Contrast-enhanced T1 MRIs of a T8 VH in an asymptomatic fourteen-year-old female ( A ) and L3, L5 VHs in a thirty-one-year-old female with back pain ( B ), illustrating the heterogenous presentation of hemangiomas on post-contrast MRI

Atypical VHs

In contrast to typical VHs, atypical VHs tend to have a higher vascular component-to-fat ratio and may not demonstrate the classical imaging findings such as the “corduroy” and “polka-dot” signs [ 5 ]. This composition gives the lesion an iso- to hypointense appearance on T1-weighted MRI as well as a very high intensity appearance on T2-weighted and fluid-sensitive MRI [ 20 , 31 ] (Fig.  4 ). Atypical VHs often mimic primary bony malignancies or metastases and are more likely to demonstrate aggressive features, often making them difficult to diagnose [ 12 , 13 , 14 , 15 ].

Asymptomatic fifty-six-year-old male with a T9 atypical vertebral hemangioma that appears iso- to hypointense on axial T1 MRI ( A ) and hyperintense on axial T2 MRI ( B ). Atypical vertebral hemangiomas of the L3 and L5 vertebral bodies in a thirty-one-year-old female who presented with backpain. Sagittal T1 ( C ) and T2 ( D ) demonstrate hypo- and hyperintense lesions respectively

Aggressive VHs

Aggressive VHs routinely have atypical features on any imaging modality [ 1 , 5 ]. They may appear radiographically normal or show nonspecific findings such as osteoporosis, pedicle erosion, cortex expansion, vertebral collapse, or irregular vertical trabeculae associated with lytic areas of varying size [ 13 , 15 ] (Fig.  5 ).

Fifty-five-year-old female with an aggressive vertebral hemangioma of the L4 vertebral body with extension into the spinal canal. A Sagittal T1 MRI shows hypo-intensity of the entire vertebral body, although vertebral height is maintained. B Sagittal T2 MRI redemonstrates the lesion but appears hyperintense due to the vascularity of the hemangioma. Axial T1 ( C ) and T2 ( D ) MRI show involvement of the pedicles bilaterally and extension of the lesion into the anterior epidural space

CT findings are often nonspecific, including features such as extraosseous soft tissue expansion, cortical ballooning, or cortical lysis [ 34 , 35 ]. As with atypical VHs, the “corduroy” and “polka-dot” signs may not be readily visualized in aggressive or destructive lesions due to the higher vascular-to-fat ratio common in these hemangiomas [ 5 ]. However, it is important to be mindful of these signs because they can guide to the correct diagnosis. Other CT features that may assist in the diagnosis of inconspicuous VHs include extension of the lesion into the neural arch, involvement of the entire vertebral body, or an irregular honeycomb pattern due to serpentine vascular channels and fatty proliferation within the network of reorganizing bony trabeculae [ 20 ]. Vertebral fractures are rare due to the reinforcement of vertical trabeculae [ 1 ].

The composition of aggressive VHs, with a hypervascular stroma and less fat, results in a hypointense lesion on T1-weighted MRI [ 20 , 31 ] (Fig.  5 ). Again, this may conceal the “corduroy” and “polka-dot” signs which remain amongst the most useful imaging findings in the diagnosis of VHs, particularly in cases where other findings are nonspecific [ 5 ]. These non-specific findings may include hyperintensity on T2-weighted MRI due to the vascular components of the lesion (Fig.  5 ), which is also seen in most neoplastic and inflammatory lesions [ 31 ]. Areas of hyperintensity on fluid-sensitive MRI and the presence of lipid-dense content within the lesion may be seen as well [ 31 , 36 ]. Other features suggestive of an aggressive VH include a maintained vertebral body height, a sharp margin with normal marrow, an intact cortex adjacent to a paraspinal mass, or enlarged paraspinal vessels, however these findings are also nonspecific and relatively uncommon [ 5 , 13 ]. Although highly unusual, there have been cases of aggressive VHs with extensive intraosseous fatty stroma and simultaneous extraosseous extension of the lesion, permitting a straightforward diagnosis [ 36 ].

Even though some aggressive VHs may be diagnosed on CT and MRI, challenging cases may warrant the use of more advanced imaging techniques for accurate diagnosis. Higher fluid content relative to cellular soft tissue gives hemangiomas a bright appearance on diffusion weighted imaging (DWI) with elevated apparent diffusion coefficient (ADC) values, distinguishing them from metastases [ 37 ]. Volume transfer constant (K trans ) and plasma volume, which reflect capillary permeability and vessel density respectively, are quantitative measures derived from dynamic contrast enhanced magnetic resonance imaging (DCE MRI) perfusion imaging that can also be used to differentiate VHs and metastases [ 38 ]. K trans and plasma volume are both low in VHs and elevated in metastatic lesions [ 38 ]. Furthermore, aggressive VHs may show a signal drop when comparing non-contrast T1-weighted MRI with and without fat suppression, as well as microscopic lipid content on chemical shift imaging [ 39 ]. Finally, characteristic findings of aggressive VHs in angiography include vertebral body arteriole dilation, multiple capillary phase blood pools, and complete vertebral body opacification [ 15 ].

Laredo et al. [ 15 ] proposed a six-point scoring system to assist in the diagnosis of aggressive VHs based on the more common features observed in radiographs and CT. One point was given for each of the following findings: a soft tissue mass, thoracic location between T3–T9, involvement of the entire vertebral body, an irregular honeycomb appearance, cortical expansion, and extension into the neural arch [ 15 ]. The authors suggest that aggressive VHs should be suspected when a patient presents with nerve root pain in association with three or more of these features [ 15 ]. However, additional studies are needed to determine the utility of this scoring system as the predictive power has not been determined [ 5 ].

Some VHs are difficult to diagnose because they can have nonspecific findings on radiographs, CT, and MRI, making characteristic findings such as the “corduroy” and “polka-dot” signs, when present, important diagnostic features. VHs may also coexist with other vertebral lesions, further complicating the diagnosis. In these cases, angiography can differentiate a VH from a nonvascular lesion [ 40 ]. Ultimately, a biopsy may be required for accurate diagnosis, especially when there is potential for a malignant lesion such as angiosarcoma or epithelioid hemangioendothelioma.

Clinical features

VHs are often noted incidentally on spinal imaging and are often observed in patients in their fifth to sixth decade of life. Studies have shown that vertebral hemangiomas exhibit a slight female preponderance, with a male-to-female ratio of 1:1.5. [ 6 ]. Clinically, most VHs are asymptomatic and quiescent lesions, which rarely demonstrate active behavior and become symptomatic [ 41 ]. VHs occur most frequently in the thoracic spine [ 42 ], followed by the lumbar spine and cervical spine; sacral involvement is very rare [ 43 ].

When symptomatic, VHs can present with localized back pain or result in neurologic symptoms that are attributable to spinal cord compression, nerve root compression, or both, leading to myelopathy and/or radiculopathy [ 1 ]. At least 4 mechanisms of spinal cord and nerve root compression have been suggested: (1) hypertrophy or ballooning of the posterior cortex of the vertebral body caused by the angioma, (2) extension of the angioma through the cortex into the epidural space, (3) compression fracture of the involved vertebra, and (4) epidural hematoma [ 44 ]. When aggressive and symptomatic with spinal cord compression, VHs tend to occur in the thoracic spine [ 42 ].

Boriani et al. classified VHs into 4 groups based on the presence of symptoms and radiographic findings [ 45 ]. These include: Type I—latent, mild bony destruction with no symptoms; Type II—active, bony destruction with pain; Type III—aggressive, asymptomatic lesion with epidural and/or soft-tissue extension; and Type IV—aggressive, neurologic deficit with epidural and/or soft tissue extension.

Management options

Most VHs are asymptomatic and do not require treatment [ 1 , 21 ]. Treatment is indicated in cases with back pain or neurological symptoms, including myelopathy and/or radiculopathy, often caused by neuronal compression or vertebral fracture [ 1 ]. Previously, surgery was the primary treatment option offered to these patients, which was associated with an increased risk of complications, particularly intraoperative bleeding [ 1 ]. New modalities such as vertebroplasty have since gained traction as adjuncts or alternatives to surgery [ 1 ]. Today, there are several management options available for the treatment of symptomatic VHs, including conservative medical therapy, surgery, percutaneous techniques, radiotherapy, or a combination of these modalities [ 1 , 46 ].

There is no consensus on the best treatment strategy, however recently Teferi et. al. proposed a treatment algorithm for VHs based on their institutional experience and literature review (Fig.  6 ) [ 1 ]. They recommend conservative management for typical, asymptomatic VHs, CT-guided biopsy and metastatic workup with PET-CT for radiographically atypical VHs, surgical intervention with or without adjuvant therapy in cases with epidural spinal cord compression or vertebral compression fracture, and radiotherapy for recurrent, asymptomatic VHs following surgery.

Algorithm for diagnosis and management of VHs proposed by Teferi et al. [ 1 ]

Surgical treatment of VHs is recommended in cases with rapid or progressive neurologic symptoms including compressive myelopathy or radiculopathy [ 47 ]. Baily et al. documented the first case of surgical management for VHs after they successfully resolved a patient’s paraplegia secondary to an aggressive VH [ 48 ]. Prior to the 1960s, the average neurological recovery rate was 73% (range, 43–85%) with a mortality rate of 11.7% [ 49 ]. This is consistent with a series published by Ghormley et al. in 1941 where 5 symptomatic VH patients were treated with decompressive laminectomy and postoperative radiotherapy. Although three patients achieved partial or complete resolution of neurologic deficits, the procedure resulted in the death of the remaining two patients secondary to significant blood loss [ 50 ]. There were very few cases of symptomatic VHs documented prior to the 1960s, with one literature review reporting only 64 instances of VHs with neurologic dysfunction [ 49 ]. More recent studies demonstrate improvement in surgical outcomes with neurological recovery reaching 100% and mortality as low as 0% [ 42 ].

The goal of surgery is to decompress neural elements and stabilize the spine [ 1 ]. Potential options include corpectomy, involving resection of a portion of the vertebral body containing the hemangioma, followed by anterior column reconstruction and/or laminectomy, which offers indirect decompression [ 1 ]. The selected approach depends on the size of the hemangioma and the extent of vertebral body and/or neural arch involvement due to potential weaknesses in the anterior column and the location of the epidural intrusion into the spinal canal [ 1 ]. For example, corpectomy and reconstruction could be performed in cases with ventral spinal cord compression while cases with dorsal compression could be treated with laminectomy [ 1 ].

Corpectomy has an increased risk of substantial intraoperative blood loss, up to 5 L in some cases, due to the hypervascular nature of VHs [ 1 , 51 ]. Acosta et al. reported an average blood loss of 2.1 L in their series of 10 aggressive VHs treated with corpectomy [ 51 ]. Conversely, laminectomy has a lower surgical burden and reduced risk of significant intraoperative blood loss [ 1 ]. Laminectomy blood loss can be further reduced by nearly 50% by performing vertebroplasty before laminectomy [ 8 ]. Preoperative embolization of VHs should also be considered to minimize intraoperative blood loss and reduce mortality [ 1 , 22 ].

Goldstein et al. demonstrated that en bloc resection may not be necessary, as intralesional resection produced equivalent long-term survival and prevention of recurrence in their series of 65 patients [ 47 ]. However, there have not been any large-scale studies comparing outcomes and recurrence rates of indirect decompression versus corpectomy [ 1 ].

The treatment algorithm proposed by Teferi et al. suggests dividing symptomatic VH patients with radiculopathy or neurological deficit into cohorts of epidural spinal cord compression (ESCC) versus vertebral body compression fracture to determine appropriate surgical intervention (Fig.  6 ) [ 1 ]. Patients with ESCC are encouraged to undergo preoperative embolization followed by laminectomy with or without fusion depending on spinal stability, or preoperative embolization followed by corpectomy and fusion if ESCC is accompanied by extensive anterior column compromise [ 1 ]. Conversely, the recommended treatment for symptomatic VHs secondary to vertebral body compression fracture is posterior laminectomy with decompression and fusion [ 1 ].

Whether through corpectomy or laminectomy, surgical management of VHs has a low recurrence rate [ 1 ]. Piper et al. reported complete remission in 84% of VHs treated surgically in their 2020 meta-analysis [ 52 ]. They also reported a severe complication rate, including pathological fracture, significant intraoperative blood loss, wound infection, and cerebrospinal fluid leak, of 3.5% [ 1 , 52 ].

Percutaneous techniques

Percutaneous techniques include vertebroplasty, sclerotherapy, and embolization which have been rising in popularity as treatment options for VHs in isolation or in combination with surgery [ 1 ].

Vertebroplasty is a minimally invasive procedure that improves the structural integrity of a vertebra by injecting an acrylic compound, such as polymethyl methacrylate (PMMA), into a lesion [ 1 ]. It was first utilized in the treatment of VHs by Galibert et al. in 1987 [ 53 ]. PMMA causes thrombosis and irreversible sclerosis of the hemangiomatous venous pool, shrinking the lesion and consolidating trabecular microfractures [ 1 ]. It allows for rapid recovery of mobility, enhances anterior column support, and provides vertebral stabilization, but does not induce new bone formation due to poor biological activity and absorbability [ 54 , 55 ]. Vertebroplasty is particularly effective in alleviating back pain in VH patients with intravertebral fractures by providing an immediate analgesic effect and has previously been recommended as stand-alone first line therapy for VHs with moderate to severe back pain without neurologic compromise [ 1 , 54 ]. It can also be used in combination with surgery to reduce intraoperative blood loss when given as a preoperative adjunct therapy [ 8 ]. The most common complication of vertebroplasty is extravasation of injected compound outside the vertebral body with rates of 20–35% [ 55 , 56 ]. However, some researchers suggest small amounts of extravasation should be considered a stopping point rather than a complication as the vast majority of cases are asymptomatic [ 55 , 56 ]. In a series of 673 vertebroplasty cases, Layton et al. reported extravasation in 25% of patients with only 1% developing clinical symptoms of new onset radiculopathy (5 patients) or symptomatic pulmonary embolism (1 patient) [ 56 ]. Their second most common complication was rib fracture related to lying prone on the fluoroscopy table during the procedure which occurred in 1% of cases (7 patients) [ 56 ].

Alternatively, sclerotherapy involves direct intralesional injection of ethanol under percutaneous CT-guidance which causes thrombosis and destruction of endothelium, resulting in devascularization, shrinkage of the lesion, and, consequently, decompression of the neural elements [ 46 ]. It was first described as a treatment for VHs in 1994 by Heiss et al. and is less common in the treatment of VHs [ 57 ]. CT angiography is a prerequisite to target the most hypervascular subsection of the lesion and ensure patients are candidates for the procedure without leakage of contrast media, which occurred in 25% of patients in a series of 18 cases [ 58 ]. There are reports of intraoperative sclerotherapy as an adjunct to surgery, but the sample sizes are similarly limited [ 59 , 60 ]. Complications of direct ethanol injection include neurologic deterioration (including Brown- Sequard syndrome), pathologic fractures, and VH recurrence [ 46 , 61 ].

The last option for percutaneous intervention is trans-arterial embolization of feeding vessels using particulate agents [ 1 ]. It has been used as a preoperative adjunct therapy with surgery to reduce blood loss as well as a primary treatment for VHs alone or in conjunction with vertebroplasty [ 41 , 62 , 63 , 64 ]. In a series of 26 patients, Premat et al. demonstrated embolization combined with vertebroplasty was safe and effective in treating pain associated with aggressive VHs but was less effective in resolving motor deficits [ 65 ]. The primary role for embolization in the treatment of compressive VHs is preoperative adjunct therapy to reduce the risk of procedural bleeding [ 62 ].

• Radiotherapy

Radiotherapy (XRT) is a noninvasive approach that can obliterate hemangiomas and relieve pain through vascular necrosis and/or anti-inflammatory effects [ 1 ]. It is a suitable option for VH patients with back pain and no neurologic deficits, or as postoperative adjunct therapy after suboptimal surgical decompression. Patients with neural element compromise often require prompt decompression to prevent irreversible injury that is more appropriately managed with surgery rather than the delayed response offered by XRT [ 1 , 21 , 66 ]. Neurological deficits may, in fact, be aggravated by XRT, as demonstrated in 20% of patients with aggressive VHs from a series of 29 cases by Jiang et al. [ 8 ]. Multiple studies have proclaimed a 60–80% success rate in eliminating symptoms from VHs using XRT, which increases to over 90% when including partial symptom relief [ 8 , 67 , 68 ]. This does include neurological deficits in some cases, but the response of these symptoms to XRT continues to vary [ 52 ]. A radiation dose of at least 34 Gy was recommended by Heyd et al. after their multicenter study identified significantly greater symptom relief and recurrence control compared to lower doses [ 67 ].

XRT is gaining popularity as a postoperative adjunct therapy intended to reduce local recurrence, especially in subtotal resections [ 8 , 52 , 67 ]. There is a 50% recurrence rate in partial resections without adjunct XRT [ 8 , 11 ]. The extent to which XRT can reduce recurrence has not been fully elucidated and has been suggested for future study [ 52 ]. However, these potential benefits must be weighed against the known adverse effects including nausea, fatigue, anorexia, ileus, radionecrosis, and specifically in spinal XRT, radiation myelitis [ 1 , 8 , 52 ].

VHs are often asymptomatic, incidental findings on routine spinal imaging that do not require treatment or follow-up imaging unless they become symptomatic. Most can be diagnosed with characteristic CT and MRI findings while atypical lesions may be difficult to differentiate from alternative diagnoses. Some authors suggest the utilization of emerging imaging techniques such as DWI or DCE MRI to differentiate atypical lesions from malignancies, which is a promising solution that requires further research. Other authors suggest observation with regular follow-up may be the best course of management for asymptomatic, atypical lesions while others still recommend biopsy for definitive diagnosis of atypical lesions. Regardless, there is a consensus that symptomatic lesions should be treated. Most authors recommend surgical decompression for treatment in patients with neurological deficits, but there is ongoing debate as to the optimal treatment for back pain alone. There are several treatment options which should be considered case-by-case given the properties of various lesions. Management algorithms have been suggested but additional research is required to identify the optimal treatment for the many different classifications of VHs.

Availability of data and materials

Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.

Abbreviations

• Vertebral hemangioma

Computed tomography

Magnetic resonance imaging

Arteriovenous

Positron emission-computed tomography

Technetium 99-methyl diphosphonate

Diffusion weighted imaging

Apparent diffusion coefficient

Volume transfer constant

Dynamic contrast enhanced magnetic resonance imaging

Epidural spinal cord compression

Polymethyl methacrylate

Teferi N, Chowdhury AJ, Mehdi Z, Challa M, Eschbacher K, Bathla G, Hitchon P. Surgical management of symptomatic vertebral hemangiomas: a single institution experience and literature review. Spine J. 2023;23(9):1243–54.

Article   PubMed   Google Scholar  

Rodallec MH, Feydy A, Larousserie F, Anract P, Campagna R, Babinet A, Zins M, Drapé JL. Diagnostic imaging of solitary tumors of the spine: what to do and say. Radiographics. 2008;28(4):1019–41.

Baudrez V, Galant C, Vande Berg BC. Benign vertebral hemangioma: MR-histological correlation. Skelet Radiol. 2001;30:442–6.

Article   CAS   Google Scholar  

Huvos AG. Hemangioma, lymphangioma, angiomatosis/lymphangiomatosis, glomus tumor. Bone tumors: diagnosis, treatment, and prognosis. 2nd ed. Philadelphia: Saunders. 1991;553–78.

Gaudino S, Martucci M, Colantonio R, Lozupone E, Visconti E, Leone A, Colosimo C. A systematic approach to vertebral hemangioma. Skelet Radiol. 2015;44:25–36.

Article   Google Scholar  

Campanacci M. Hemangioma. In: Campanacci M, editors. Bone and soft tissue tumors: clinical features, imaging, pathology and treatment. Padova: Piccin Nuova Libraria & Wien: Springer; 1999. p. 599–618.

Hameed M, Wold LE. Hemangioma. In: Fletcher CDM, Bridge JA, Hogendoorn P, Mertens F, editors. WHO classification of tumors of soft tissue and bone. 4th ed. Lyon: IARC Press; 2013. p. 332.

Google Scholar  

Jiang L, Liu XG, Yuan HS, Yang SM, Li J, Wei F, Liu C, Dang L, Liu ZJ. Diagnosis and treatment of vertebral hemangiomas with neurologic deficit: a report of 29 cases and literature review. Spine J. 2014;14(6):944–54.

Unni KK, Inwards CY. Dahlin's bone tumors: general aspects and data on 10,165 cases. Lippincott Williams & Wilkins; 2010.

Corniola MV, Schonauer C, Bernava G, Machi P, Yilmaz H, Lemée JM, Tessitore E. Thoracic aggressive vertebral hemangiomas: multidisciplinary management in a hybrid room. Eur Spine J. 2020;29:3179–86.

Fox MW, Onofrio BM. The natural history and management of symptomatic and asymptomatic vertebral hemangiomas. J Neurosurg. 1993;78(1):36–45.

Article   CAS   PubMed   Google Scholar  

Murphey MD, Fairbairn KJ, Parman LM, Baxter KG, Parsa MB, Smith WS. From the archives of the AFIP. Musculoskeletal angiomatous lesions: radiologic-pathologic correlation. Radiographics. 1995;15(4):893–917.

Cross JJ, Antoun NM, Laing RJ, Xuereb J. Imaging of compressive vertebral haemangiomas. Eur Radiol. 2000;10:997–1002.

Alexander J, Meir A, Vrodos N, Yau YH. Vertebral hemangioma: an important differential in the evaluation of locally aggressive spinal lesions. Spine. 2010;35(18):E917–20.

Laredo JD, Reizine D, Bard M, Merland JJ. Vertebral hemangiomas: radiologic evaluation. Radiology. 1986;161(1):183–9.

Elgazzar AH. Musculoskeletal system. In: Synopsis of pathophysiology in nuclear medicine. New York: Springer; 2014. p. 90–2.

Choi YY, Kim JY, Yang SO. PET/CT in benign and malignant musculoskeletal tumors and tumor-like conditions. In: Editors. Seminars in musculoskeletal radiology. Thieme Medical Publishers; 2014. pp. 133–48

Brogsitter C, Hofmockel T, Kotzerke J. 68Ga DOTATATE uptake in vertebral hemangioma. Clin Nucl Med. 2014;39(5):462–3.

Basu S, Nair N. “Cold” vertebrae on F-18 FDG PET: causes and characteristics. Clin Nucl Med. 2006;31(8):445–50.

Laredo JD, Assouline E, Gelbert F, Wybier M, Merland JJ, Tubiana JM. Vertebral hemangiomas: fat content as a sign of aggressiveness. Radiology. 1990;177(2):467–72.

Dang L, Liu C, Yang SM, Jiang L, Liu ZJ, Liu XG, Yuan HS, Wei F, Yu M. Aggressive vertebral hemangioma of the thoracic spine without typical radiological appearance. Eur Spine J. 2012;21:1994–9.

Article   PubMed   PubMed Central   Google Scholar  

Kato S, Kawahara N, Murakami H, Demura S, Yoshioka K, Okayama T, Fujita T, Tomita K. Surgical management of aggressive vertebral hemangiomas causing spinal cord compression: long-term clinical follow-up of five cases. J Orthop Sci. 2010;15:350–6.

Klekamp J, Samii M. Epidermal Tumors. In: Surgery of spinal tumors. Springer; 2007. p. 321–522.

Blecher R, Smorgick Y, Anekstein Y, Peer A, Mirovsky Y. Management of symptomatic vertebral hemangioma: follow-up of 6 patients. Clin Spine Surg. 2011;24(3):196–201.

Subramaniam MH, Moirangthem V, Venkatesan M. Management of aggressive vertebral haemangioma and assessment of differentiating pointers between aggressive vertebral haemangioma and metastases—a systematic review. Global Spine J. 2023;13(4):1120–33.

Hart JL, Edgar MA, Gardner JM. Vascular tumors of bone. In: Seminars in diagnostic pathology. WB Saunders; 2014. p. 30–8.

Dorfman HD, Czerniak B. Vascular lesions. In: Dorfman HD, Czerniak B, editors. Bone tumors. St. Louis: Mosby; 1998. p. 729–814.

Rudnick J, Stern M. Symptomatic thoracic vertebral hemangioma: a case report and literature review. Arch Phys Med Rehabil. 2004;85(9):1544–7.

Pastushyn AI, Slin’ko EI, Mirzoyeva GM. Vertebral hemangiomas: diagnosis, management, natural history and clinicopathological correlates in 86 patients. Surg Neurol. 1998;50(6):535–47.

Blankstein A, Spiegelmann R, Shacked I, Schinder E, Chechick A. Hemangioma of the thoracic spine involving multiple adjacent levels: case report. Spinal Cord. 1988;26(3):186–91.

Hanrahan CJ, Christensen CR, Crim JR. Current concepts in the evaluation of multiple myeloma with MR imaging and FDG PET/CT. Radiographics. 2010;30(1):127–42.

Ross JS, Masaryk TJ, Modic MT, Carter JR, Mapstone T, Dengel FH. Vertebral hemangiomas: MR imaging. Radiology. 1987;165(1):165–9.

Persaud T. The polka-dot sign. Radiology. 2008;246(3):980–1.

Nguyen JP, Djindjian M, Gaston A, Gherardi R, Benhaiem N, Caron JP, Poirier J. Vertebral hemangiomas presenting with neurologic symptoms. Surg Neurol. 1987;27(4):391–7.

Gaston A, Nguyen JP, Djindjian M, Le Bras F, Gherardi R, Benhaiem N, Marsault C. Vertebral haemangioma: CT and arteriographic features in three cases. J Neuroradiol. 1985;12(1):21–33.

CAS   PubMed   Google Scholar  

Friedman DP. Symptomatic vertebral hemangiomas: MR findings. AJR Am J Roentgenol. 1996;167(2):359–64.

Winfield JM, Poillucci G, Blackledge MD, Collins DJ, Shah V, Tunariu N, Kaiser MF, Messiou C. Apparent diffusion coefficient of vertebral haemangiomas allows differentiation from malignant focal deposits in whole-body diffusion-weighted MRI. Eur Radiol. 2018;28:1687–91.

Morales KA, Arevalo-Perez J, Peck KK, Holodny AI, Lis E, Karimi S. Differentiating atypical hemangiomas and metastatic vertebral lesions: the role of T1-weighted dynamic contrast-enhanced MRI. Am J Neuroradiol. 2018;39(5):968–73.

Article   CAS   PubMed   PubMed Central   Google Scholar  

Shi YJ, Li XT, Zhang XY, Liu YL, Tang L, Sun YS. Differential diagnosis of hemangiomas from spinal osteolytic metastases using 3.0 T MRI: comparison of T1-weighted imaging, chemical-shift imaging, diffusion-weighted and contrast-enhanced imaging. Oncotarget. 2017;8(41):71095–104.

McEvoy SH, Farrell M, Brett F, Looby S. Haemangioma, an uncommon cause of an extradural or intradural extramedullary mass: case series with radiological pathological correlation. Insights Imaging. 2016;7(1):87–98.

Teferi N, Abukhiran I, Noeller J, Helland LC, Bathla G, Ryan EC, Nourski KV, Hitchon PW. Vertebral hemangiomas: diagnosis and management. A single center experience. Clin Neurol Neurosurg. 2020;190:105745.

Acosta FL Jr, Sanai N, Chi JH, Dowd CF, Chin C, Tihan T, Chou D, Weinstein PR, Ames CP. Comprehensive management of symptomatic and aggressive vertebral hemangiomas. Neurosurg Clin N Am. 2008;19(1):17–29.

Wang B, Zhang L, Yang S, Han S, Jiang L, Wei F, Yuan H, Liu X, Liu Z. Atypical radiographic features of aggressive vertebral hemangiomas. JBJS. 2019;101(11):979–86.

Jayakumar PN, Vasudev MK, Srikanth SG. Symptomatic vertebral haemangioma: endovascular treatment of 12 patients. Spinal cord. 1997;35(9):624–8.

Boriani S, Weinstein JN, Biagini R. Primary bone tumors of the spine: terminology and surgical staging. Spine. 1997;22(9):1036–44.

Doppman JL, Oldfield EH, Heiss JD. Symptomatic vertebral hemangiomas: treatment by means of direct intralesional injection of ethanol. Radiology. 2000;214(2):341–8.

Goldstein CL, Varga PP, Gokaslan ZL, Boriani S, Luzzati A, Rhines L, Fisher CG, Chou D, Williams RP, Dekutoski MB, Quraishi NA. Spinal hemangiomas: results of surgical management for local recurrence and mortality in a multicenter study. Spine. 2015;40(9):656–64.

Bailey P, Bucy PC. Cavernous hemangioma of the vertebrae. J Am Med Assoc. 1929;92(21):1748–51.

Krueger EG, Sobel GL, Weinstein C. Vertebral hemangioma with compression of spinal cord. J Neurosurg. 1961;18(3):331–8.

Ghormley RK, Adson AW. Hemangioma of vertebrae. JBJS. 1941;23(4):887–95.

Acosta FL Jr, Sanai N, Cloyd J, Deviren V, Chou D, Ames CP. Treatment of Enneking stage 3 aggressive vertebral hemangiomas with intralesional spondylectomy: report of 10 cases and review of the literature. Clin Spine Surg. 2011;24(4):268–75.

Piper K, Zou L, Li D, Underberg D, Towner J, Chowdhry AK, Li YM. Surgical management and adjuvant therapy for patients with neurological deficits from vertebral hemangiomas: a meta-analysis. Spine. 2020;45(2):E99-110.

Galibert P, Deramond H, Rosat P, Le Gars D. Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty. Neurochirurgie. 1987;33(2):166–8.

Guarnieri G, Ambrosanio G, Vassallo P, Pezzullo MG, Galasso R, Lavanga A, Izzo R, Muto M. Vertebroplasty as treatment of aggressive and symptomatic vertebral hemangiomas: up to 4 years of follow-up. Neuroradiology. 2009;51:471–6.

Kim BS, Hum B, Park JC, Choi IS. Retrospective review of procedural parameters and outcomes of percutaneous vertebroplasty in 673 patients. Interv Neuroradiol. 2014;20(5):564–75.

Layton KF, Thielen KR, Koch CA, Luetmer PH, Lane JI, Wald JT, Kallmes DF. Vertebroplasty, first 1000 levels of a single center: evaluation of the outcomes and complications. Am J Neuroradiol. 2007;28(4):683–9.

CAS   PubMed   PubMed Central   Google Scholar  

Heiss JD, Doppman JL, Oldfield EH. Relief of spinal cord compression from vertebral hemangioma by intralesional injection of absolute ethanol. N Engl J Med. 1994;331(8):508–11.

Bas T, Aparisi F, Bas JL. Efficacy and safety of ethanol injections in 18 cases of vertebral hemangioma: a mean follow-up of 2 years. Spine. 2001;26(14):1577–81.

Murugan L, Samson RS, Chandy MJ. Management of symptomatic vertebral hemangiomas: review of 13 patients. Neurol India. 2002;50(3):300.

Singh P, Mishra NK, Dash HH, Thyalling RK, Sharma BS, Sarkar C, Chandra PS. Treatment of vertebral hemangiomas with absolute alcohol (ethanol) embolization, cord decompression, and single level instrumentation: a pilot study. Neurosurgery. 2011;68(1):78–84.

Niemeyer T, McClellan J, Webb J, Jaspan T, Ramli N. Brown-Sequard syndrome after management of vertebral hemangioma with intralesional alcohol: a case report. Spine. 1999;24(17):1845.

Singh PK, Chandra PS, Vaghani G, Savarkar DP, Garg K, Kumar R, Kale SS, Sharma BS. Management of pediatric single-level vertebral hemangiomas presenting with myelopathy by three-pronged approach (ethanol embolization, laminectomy, and instrumentation): a single-institute experience. Childs Nerv Syst. 2016;32:307–14.

Yao KC, Malek AM. Transpedicular N-butyl cyanoacrylate-mediated percutaneous embolization of symptomatic vertebral hemangiomas. J Neurosurg Spine. 2013;18(5):450–5.

Kawahara N, Tomita K, Murakami H, Demura S, Yoshioka K, Kato S. Total en bloc spondylectomy of the lower lumbar spine: a surgical techniques of combined posterior-anterior approach. Spine. 2011;36(1):74–82.

Premat K, Clarençon F, Cormier É, Mahtout J, Bonaccorsi R, Degos V, Chiras J. Long-term outcome of percutaneous alcohol embolization combined with percutaneous vertebroplasty in aggressive vertebral hemangiomas with epidural extension. Eur Radiol. 2017;27:2860–7.

Yang ZY, Zhang LJ, Chen ZX, Hu HY. Hemangioma of the vertebral column: a report on twenty-three patients with special reference to functional recovery after radiation therapy. Acta Radiol Oncol. 1985;24(2):129–32.

Heyd R, Seegenschmiedt MH, Rades D, Winkler C, Eich HT, Bruns F, Gosheger G, Willich N, Micke O, German Cooperative Group on Radiotherapy for Benign Diseases. Radiotherapy for symptomatic vertebral hemangiomas: results of a multicenter study and literature review. Int J Radiat Oncol* Biol* Phys. 2010;77(1):217–25.

Asthana AK, Tandon SC, Pant GC, Srivastava A, Pradhan S. Radiation therapy for symptomatic vertebral haemangioma. Clin Oncol. 1990;2(3):159–62.

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Kyle Kato & Meron Challa

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KK performed a portion of the literature review and was a major contributor in writing the manuscript/generating figures. NT performed most of the literature review and was a major contributor in reviewing the manuscript. MC contributed to writing the manuscript. KE provided histological images for figures. SY was a major contributor in reviewing the manuscript. All authors read and approved the final manuscript.

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Kato, K., Teferi, N., Challa, M. et al. Vertebral hemangiomas: a review on diagnosis and management. J Orthop Surg Res 19 , 310 (2024). https://doi.org/10.1186/s13018-024-04799-5

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Pain Management Research *

Over the past decade, increased awareness by the medical profession of the devastating consequences of opioid addiction has resulted in substantial efforts to limit the number of opioid prescriptions for both perioperative pain management and chronic pain. While these efforts have had some success, opioid misuse remains a crisis, which we in the orthopaedic community have a particular opportunity to address. It is the belief of the undersigned that progress depends on improved research methods and reporting to further the understanding of pain experience and response to management, with the end goal of identifying more effective, nonnarcotic pain control measures for our orthopaedic patients.

To further these efforts, JBJS, with support from an R-13 scientific meeting grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases, conducted a Symposium on Pain Management Research in Newton, Massachusetts, on November 19, 2019. At this meeting, 10 experts in pain research along with 12 orthopaedic journal editors came together to present and discuss the latest findings on perioperative musculoskeletal pain management, define unmet clinical needs, and develop a set of guiding principles for the next phase of research in this arena. This endeavor came to fruition in a series of papers published as the JBJS Supplement on Pain Management Research as well as a summary list of Recommendations for Pain Management Research based on those papers and the meeting itself.

We hope that investigators will find the JBJS Supplement on Pain Management Research to be a useful guide when designing and reporting future studies. Again, we believe that strengthening the integrity of pain management research is key to winning the battle against the opioid crisis, which requires moving away from narcotics as a primary mode of pain relief while improving the pain experience of our patients.

Recommendations for Pain Management Research *

• 1. Definition: Define all terms (such as “new opioid prescrip- tion” or “long-term opioid use”) precisely, using criteria established by the Centers for Disease Control and Prevention (CDC) or a similar institution if possible. If a more established descriptor is not applicable to the database, explain why and clearly state the criteria for the definition used.
• 2. Quantification: Quantifying opioid use in morphine milligram equivalents (MMEs) enables comparisons within the literature. As >1 conversion factor is available, state how MMEs were calculated. The CDC provides a toolkit for calculating MMEs.
• 3. Population: As different groups experience pain differently, the study population (age, sex, socioeconomic, cultural) should be defined precisely. Research on sex-based differ- ences in pain experienced and response to opioids is needed.
• 4. Risk factors/predictors: Factors such as previous pain/opioid use, demographics, depression, catastrophizing, expectations, sleep disturbance, somatosensory function, physical activity, and coping ability should be studied as contributors to musculoskeletal pain and risk of opioid overuse.
• 5. The key measure should be better patient-related outcomes—including a positive experience that is free of complications and excessive pain—not just number of pills taken.
• 6. Distinguish among medications prescribed, obtained, and consumed. Be clear about the methods used to obtain these data and their limitations.
• 7. Pain relief using alternative strategies (nonsteroidal anti-inflammatory drugs [NSAIDs], ice, nerve growth factor inhibitors, psychological interventions), as opposed to elimi- nation of opioids, should be a goal. n

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Funding for the Pain Management Research Symposium was made possible (in part) by a grant (1R13AR076879-01) from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention by trade names, commercial practices, or organizations imply endorsement by the U.S. Government. The Disclosure of Potential Conflicts of Interest form is provided with the online version of the article ( http://links.lww.com/JBJS/F816 ).

Funding: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: NIH.

OA: Copyright © 2020 The Authors. Published by The Journal of Bone and Joint Surgery , Incorporated. All rights reserved. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

doi:10.2106/JBJS.20.00289

* This editorial is also being published in The Journal of Bone and Joint Surgery, The Spine Journal, The Journal of Hand Surgery, Journal of Pediatric Orthopaedics, Journal of Shoulder and Elbow Surgery , and Arthroscopy : The Journal of Arthroscopic and Related Surgery . Michael Pinzur, MD, Assistant Editor, attended this symposium representing Foot & Ankle International .

* These recommendations are based on presentations and discussions at the Pain Management Research Symposium held in Newton, Massachusetts, on November 19, 2019, as well as the articles in the Supplement on Pain Management Research (J Bone Joint Surg Am. 2020 May 21;102[Supplement 1]) authored by experts in pain research participating in that meeting.

Disclosure: Funding for this conference was made possible (in part) by a grant (1R13AR076879-01) from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention by trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

Copyright © 2020 The Authors. Published by The Journal of Bone and Joint Surgery, Incorporated This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

J Bone Joint Surg Am. 2020;00:1-1 d http://dx.doi.org/10.2106/JBJS.20.00291

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