1479. Antepartum Decompression for Pregnancy-Related Aggressive Vertebral Hemangioma
Authors: H. Westley Phillips, MD; Genaro Villa, MD, PhD; Osama Elbuluk, MD; Mari Perez-Rosendahl, MD; Illiana Datkhaeva, MD; Daniel Lu, MD, PhD (Los Angeles, CA)
Vertebral hemangiomas are benign vascular tumors of the spine with a prevalence of 10-12% in the general population. These lesions present with variable symptoms which may be nonspecific. Pregnancy is a recognized risk factor for the symptomatic progression of vertebral hemangiomas and initial symptoms are often mistakenly attributed to a normal pregnancy. However, disease progression can lead to neurologic deterioration resulting in a surgical dilemma given the risk of neurologic deficits to the mother versus the risk of adverse affects to the fetus if surgery is performed.
We report a case of an aggressive thoracic vertebral hemangioma in a 30-year-old woman in her 31st week of pregnancy who presented with a 2-month history of progressive back and chest pain that progressed to bilateral lower extremity paraesthesias. Additionally, she endorsed progressive bilateral lower extremity weakness resulting in difficulty with ambulation. On exam, the patient was noted to have a T2 thoracic sensory level, 4-/5 strength and was myelopathic on exam. MRI thoracic spine revealed a T3-4 vertebral body lesion causing severe central spinal canal narrowing and cord compression.
After thorough discussion with the patient and multidisciplinary team, the patient opted for conservative management with steroids in hopes of delaying surgery.
Unfortunately, two days after the initiation of steroid therapy, the patient’s weakness progressed. Subsequently, emergency antepartum decompression at T3-4 without stabilization with concurrent aggressive fetal monitoring was performed to minimize surgical time and blood loss. Postoperatively, the patient regained full strength with delayed improvement of her sensory deficits without adverse effects to the fetus.
Antepartum surgical decompression for vertebral hemangioma in pregnancy is rare, with ten cases reported to date. With a multidisciplinary approach, surgical decompression when conservative management fails, is an effective way to preserve neurologic function while posing the least risk to the fetus.