Vol. 2 - Year 1 - December 2005

At 11/2 months postop, the patient startedgetting gradual recovery from paraplegia, withflicker of movements. Now at 3 months postop, pt.has regained Grade 4 power in both lower limbs andis walking with support.

Discussion

Even in the hands of an experienced spinesurgeon , anterior radical surgery with corddecompression and strut grafting withinstrumentation for haemangioma of a vertebral bodyposes challenges – mainly due to its tendency forprofuse bleeding. To reduce the operative morbidityand blood loss, Galibert (3) in 1987, reported theuse of PMMA cement injection in the vertebral bodypercutaneously. In 1994, Cortet et al (5) reported thevalue of vertebroplasty combined with surgical corddecompression in 3 cases of vertebral angiomas ;while Ide et al (6) ( 1996 ) tried preoperativepercutaneous vertebroplasty followed by posteriorcord decompression in cases of vertebralhaemangioma with neurodeficit in lower limbs.

However vertebroplasty and kyphoplasty arerelatively newer modalities in India and their use ismaximally reported for the cases of osteoporoticvertebral compression fractures. The relativeinfrequent occurance of vertebral body haemangiomaand the inadequate exposure to vertebroplasty as avery useful treatment modality for such casesprompted us to report our excellent experience with

it in this young girl with paraplegia. This structuralreconstruction of the involved vertebral bodyalleviates any need for corpectomy, strut bonegrafting and anterior or posterior instrumentation –thus reducing the extent of surgical procedure to alarge extent. Ofcourse the long term result is crucial:but looking at the neurological recovery and theoverall long term success of vertebroplasty for otherindications, the prognosis appears to be good.

References :1. Carnesale P.G. & Pitcock J.A. — Miscellaneous

Tumours of bone . Campbell’s Textbook of Operative Orthopaedics

2. Lane Joseph M. et al — Minimally invasive options forthe treatment of osteoporotic vertebral compression fractures. Orth.Clinics of North America , 33 ( 2002 ) 431-438

3. Galibert P, Deramond H, Rosat P, Le Gars D — Pre-liminary note on the treatment of vertebral angioma by percutane-ous acrylic vertebroplasty.

Neurochirurgie 1987 , 33 : 166-168.

4. Cortet B et al — Percutaneous vertebroplasty in pa-tients with osteolytic metastases or multiple myeloma. Rev.Rhum Engl. Ed. 1997;64 177-83

5. Cortet b Et al — Value of vertebroplasty combinedwith surgical decompression in the treatment of aggressive spinalangioma apropos of 3 cases. Rev. Rhum.Engl. Ed. 1994;1 16-22

6. Ide C, Gangi A, Rimmelin A, Beaujeux R, Maitrot G,Buchheit F et al — Vertebral haemangioma with spinal cord com-pression : the place of preoperative percutaneous vertebroplastywith methyl methacrylate. Neuroradiology 1996 ; 38 585-589.

c c c

103