Pain pattern in multiple vertebral hemangiomas involving nonadjacent levels: report of two cases

Hemangioma of the bone is a benign tumor usually involving the spine and th e bones of the skull and pelvis. It may be either a single lesion or part o f a generalized multifocal disease. Multiple lesions involving non-adjacent vertebrae are rare. Two cases of multiple vertebral hemangiomas at non-adj acent levels with different pain patterns are presented at various stages o f follow-up in order to emphasize the fact that multiple vertebral hemangio mas may present with different clinical characteristics over a long period of time. The change in the location and pattern of the initially presented pain in both patients suggested the passibility of multiple level involveme nt. Investigation revealed multiple hemangiomas involving three non-adjacen t vertebrae in the first patient and four in the second. We stress the Fact that the existence of multiple non-adjacent lesions may remain undiagnosed for a considerable period of time and may be responsible fur even longer-t erm recurrent episodes of pain. Multifocal location of back pain in patient s with a known vertebral hemangioma may be considered a relative indication for the presence of multiple non-adjacent level lesions.