Most of the vertebral hemangiomas are diagnosed during image evaluating of a patient for another concern. The typical appearance of these tumors on plain radiograph and CT scan are honeycomb (or celery stalk) and polka dot, respectively. These are due to prominent vertical striations of thickened trabeculae within vertebral body [3].
Most of the vertebral hemangiomas do not need any treatment but clinical observation. For symptomatic lesions, the traditional treatment of choice is radiotherapy due to radiosensitive nature of the tumor [4]. Nowadays, Open surgery is rarely indicated with these lesions except for some cases with spinal cord compression. The most significant concern about open surgery of these lesions is severe hemorrhage. Bleeding from these highly vascular tumors can be effectively minimized by preoperative angiography associated with selective embolization [5].
Intralesional ethanol injection has been reported in the treatment of vertebral hemangiomas and some authors claim of its effectiveness [6].
According to Hee HT, the classic indication for PVP is severe, continuous, and localized back pain relating to one or more collapsed vertebral bodies not responding to usual conservative therapy of 4 to 12 weeks' period [7]. Therefore, the patient with vertebral fracture due to idiopathic osteoporosis, multiple myeloma, bone metastasis, hamangioma and other benign or malignant vertebral tumors may significantly improved clinically with this new and relatively safe technique [8].
The complications rate after PVP is very low but devastating. These include transient fever, mild intraoperative hypotension, temporary worsening of the fracture pain, infection, rib or adjacent segment fracture, cement leakage, neurologic deficit, and vascular involvement [9, 10]. In fact, cement leakage is the most common technical complication but clinically asymptomatic in nearly all patients. According to our best knowledge, in those neurologically symptomatic cases, the presentation is always acute and from this point our case is unique. The reason for this late onset presentation is unknown for us, although. To prevent rare significant neurologic deficit associated with PVP, intact posterior vertebral body cortex is one of the most important prerequisite that must be thoroughly confirmed preoperatively.