Question
AFTER DEVELOPING BACK PAIN TWO YEARS AGO I BEGAN SEEING A SPINAL SPECIALIST WHO DISCOVERED MY T-7 VERTEBRA HAS A HEMANGIOMA COVERING THE ENTIRE VERTEBRA.  THE PAIN HAS INCREASED RAPIDLY AT THE SITE AND HAS ALSO PROJECTED TO MY LOWER BACK.  I'VE HAD THE BONE SCAN, MRI'S, CT'S AND NUMEROUS XRAYS.  I LIVE IN MOBILE ALABAMA, USA.  WE HAVE ONLY ONE INTERVENTIONAL RADIOLOGIST THAT MY DOCTOR SENT ME TO IN ORDER TO HAVE THE INJECTION OF A CEMENTING COMPOUND.  HE REFUSED TO DO THE PROCEDURE STATING MORE THAN LIKELY IN HIS OPINION THE RISKS FAR EXCEEDED THE POSSIBLE BENEFITS.  MY SPECIALIST, WHO HAS NEVER SEEN THIS RARE OCCURRENCE THEN CONTACTED ALL OF HIS COLLEAGUES HERE AND FROM HIS COLLEGE AND PREVIOUS EMPLOYER IN MISSISSIPPI USA.  NONE OF THEM HAD EVER TREATED OR SEEN THIS TYPE HEMANGIOMA - ONLY THOSE FOUND INCIDENTALLY. HE THEN SENT ME TO THE UNIVERSITY OF ALABAMA BIRMINGHAM (UAB) WHERE THE SPECIALIST THERE SUGGESTED THE CEMENTING COMPOUND ALSO. WITH THIS, I CALLED A RELATIVE OF MINE THAT HAS BEEN A DOCTOR OF RADIOLOGY IN MONTGOMERY ALABAMA USA FOR THIRTY YEARS AND SENT HIM ALL OF THE NOTES, TEST RESULTS AND CD'S OF ALL THE TESTS.  HE LOOKED AT THEM AND THEN CONSULTED ALL OF THE RADIOLOGY DOCTORS IN HIS GROUP. THEY ALL CONCURRED THAT THIS IS VERY RARE AND NOT ONLY HAD NONE OF THEM EVER SEEN THIS LARGE OF A HEMANGIOMA BUT HAD ALSO NEVER SEEN OR DIAGNOSED ONE THAT WAS FOUND TO BE ANYTHING OTHER THAN INCIDENTAL, WITH NO SIDE EFFECTS. IN ADDITION, AFTER STUDYING ALL MY TEST THEY ALL AGREED THAT THE TUMOR IS VERY AGGRESSIVE AND PRESSING AGAINST MY SPINAL CAN ON THE LEFT SIDE.  THIS EXPLAINS THE CONSTANT, SEVERE PAIN AS WELL AS THE WEAKNESS IN MY LEGS WHICH AT TIMES MAKES THEM SO "HEAVY" THAT AFTER ONLY WALKING SHORT DISTANCES, I FEEL AS THOUGH I HAVE RAN SEVERAL MILES, BREATHING HEAVILY AND HAVING TO SIT DOWN BECAUSE OF THE WEAKNESS IN MY LEGS. THE YOUNGER INTERVENTIONAL RADIOLOGIST CONSULTED HIS PROFESSORS AND COLLEAGUES AT VANDERBILT UNIVERSITY IN TENNESSEE, USA AND THEIR RESPONSE WAS THE SAME. AS OF LAST WEEK AFTER RESEARCHING MY CASE THOROUGHLY, ALL OF THE PARTIES MENTIONED ABOVE CONCURRED THAT INSTEAD OF THE CEMENT OR RADIATION, AND BECAUSE OF THE AGGRESSIVENESS OF THE TUMOR AND IT PROXIMITY TO THE SPINAL CANAL THAT INJECTING A SCLEROSING AGENT WAS THE BEST AND MOST COMPREHENSIVE TREATMENT FOR ME, OFFERING THE QUICKEST AND MOST POSITIVE, PERMANENT  RESULTS.  OUR PROBLEM NOW IS FINDING AN INTERVENTIONAL RADIOLOGIST CLOSE TO ALABAMA, USA WHO OFFERS THIS TREATMENT.  OTHER THAN THEN IN THE NORTHEAST USA AND THE FAR WEST USA, WE HAVE YET TO FIND SOMEONE THAT IS ANYWHERE ELSE. I AM HOPEFUL YOU CAN POINT ME IN THE DIRECTION OF SOMEONE AND IF NOT, SHOULD I TRY THE CEMENT AND/OR RADIATION IN LIEU OF THE SCLEROSING AGENT?  I HAVE BEEN LAID OFF FROM MY JOB AS A BUYER SINCE JUNE 2010 DUE TO MY EMPLOYER FILING BANKRUPTCY AND DESPERATELY NEED TO GET BACK TO WORK, BUT CANNOT UNTIL THIS IS TAKEN CARE OF AND THERE IS NO MORE SEVERE PAIN. MY HUSBAND'S INSURANCE WILL COVER VERY LITTLE ON THIS PROCEDURE AND WITH ONLY HIS INCOME WE WOULD HAVE TO BORROW THE MONEY FOR TREATMENT, WHICH I AM CERTAIN WOULD BE SEVERAL THOUSAND US DOLLARS. UNDERSTAND THAT IF I HAVE NO ALTERNATIVE TO COMPLETELY ERADICATE THIS PROBLEM AND ITS POTENTIAL SEVERE RESULTS THAT WE WILL DO WHAT WE HAVE TO GET IT DONE.  WE ARE ALL JUST AT A LOSS OVER THE LAST FEW WEEKS.  I ASK YOUR OPINION AND YOUR ADVICE CONCERNING ALL OF THE ISSUES MENTIONED.  I TRULY THANK YOU IN ADVANCE FOR YOU TIME AND ANXIOUSLY AWAIT YOUR RESPONSE.

Answer
Hi Lisa,
My heart goes out to you as you cope with the pain and simultaneously search for the most sound option to deal with your pain.  I have been asked about hemangiomas before, and as you know they are usually found incidentally without any significance, the literature suggests that only 1% of hemangiomas are symptomatic and approximately 5/7 are found in the thoracic spine.  

With regards to treatment historically, surgery was the treatment of choice but has demonstrated some risks associated with excessive bleeding and is not as frequently done as has been done in the past.  

A procedure using Methyl methacrylate is showing promise. This procedure is used for the purpose of strengthening vertebrae which have been weakened by hemangiomas. Risks include possible leakage into the veins and spinal canal which can become hazardous.

Radiotherapy has some success as well however the literature suggests that there is some disagreement of appropriate doses.

Another procedure includes the direct injection of ethanol alcohol directly into the hemangioma in cases where the hemangioma is causing cord or radicular compression. This approach has demonstrated rapid relief of compression effects. The literature shows this procedure to be very effective. This procedure interests me. In one study it showed 5 out of 6 paraplegics had complete recovery and the 6th patient made considerable improvement.

I am a doctor in Canada and I don't know of any doctors in the US that have experience in this area. If I was to have a procedure done on me i would probably turn to the alcohol injection option first. This sounds to me what your team of Vanderbilt University doctors are suggesting.  

You can read up more about these procedures at the following web address:

http://www.cancerjournal.net/article.asp?issn=0973-1482;year=2010;volume=6;issue...

My best recommendation in finding an appropriate doctor to help with this procedure may lie with the Vanderbilt university doctors. They should likely be able to assist you with the search better than anyone.  As for your financial burdens you are saddled with - I hear this every day from patients and I wish I could offer you  meaningful words of comfort. The best I can say at this time is I commend you with your brilliant commitment to research your options.

I wish you a blessing of a speedy recovery and that you should find a financial option that will be sensible.  Please keep me informed on how things are going.

Can you please take a moment out after you have read this and kindly rate my answer and consider to nominate me as expert of the month.

Best wishes,
Dr. Ron Nusbaum