52 years old Male Mr Pravin Pawar had a large tumour in his sixth thoracic vertebrae. He had weakness in legs as a result of the tumour compressing on the spinal cord.
Investigations were done at Kokilaben hospital showed large haemangioma in the 6th thoracic vertebrae. Haemangioma is a vascular tumour with rich blood supply. Removing a haemangioma in vertebral body has a risk of torrential bleeding and death. There was also a risk of spinal cord injury and complete paralysis.
Fig.1 & 2 Hemangioma at D6 Vertebral body causing spinal compression
Praveen came with some hope at Kokilaben after several opinions.
Investigations were done and surgery was planned in stages.
Stage 1: The interventional radiologist embolized the tumor on Day 1. Complete embolization of all vessels was done.
Stage 2: The decompression and excision of sixth thoracic vertebrae was planned. The vertebra was approached from the posterior approach. Verterbrectomy of thoracic 6th vertebrae was done. Neuromonitoring was used in all stages to ensure safety of surgery. Cage was placed anteriorly and posterior spinal instrumentation was done. As a result of embolization there was minimal bleeding during surgery. Histopathology however showed this tumor as plasmacytoma. Radiotherapy was done. At the end of month patient had a wonderful recovery was back to walking again. With multidisciplinary approach the patient is back to walking.
Fig.3 Post operative radiograph showing complete excision of tumour and posterior spinal stabilization