Symptomatic Expansile Vertebral Hemangioma Causing Conus Medullaris Compression

Abstract 

Objective

To present a case of symptomatic, expansile L1 vertebral hemangioma.

Clinical Features

A 46-year-old man presented with progressive neurologic changes and insidious onset of low back pain.

Intervention and Outcome

After a trial of 3 visits of conservative chiropractic care, no improvement was noted. Magnetic resonance imaging was obtained, revealing an expansile hemangioma with extra-osseous component compromising the conus medullaris at the level of the L1 lumbar vertebra. Neurosurgical intervention resulted in clinical improvement.

Conclusion

Primary care physicians treating patients with low back pain should be aware of neurologic red flags requiring prompt attention. Magnetic resonance imaging is the imaging modality of choice when evaluating a neurologic abnormality presumably related to a space-occupying lesion. Although a disk herniation is the most common cause of these symptoms, clues in the history and examination must prompt physicians to expand their differential diagnosis to include a variety of other extradural masses (J Manipulative Physiol Ther 2005;28:000-000).