{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T11:05:52Z","timestamp":1778756752374,"version":"3.51.4"},"reference-count":25,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2023,6,8]],"date-time":"2023-06-08T00:00:00Z","timestamp":1686182400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Vertebral hemangiomas of the spine are rare benign tumors. They occur primarily in the thoracic region and are often asymptomatic and found incidentally on radiological examination; however, some are symptomatic, aggressive, and gradually increase in size. Various therapeutic approaches have been proposed for their management. This study aimed to review the therapeutic management, focusing on ethanol sclerosis therapy. The PubMed database was searched from inception to January 2023 using the keywords \u201chemangioma\u201d, \u201cspine OR vertebra\u201d, and \u201cethanol\u201d. Twenty studies were retrieved, including two letters. The first report of spinal therapy was published in 1994. Ethanol sclerosis therapy is effective in treating vertebral hemangiomas. It is performed independently or in combination with other techniques, such as vertebroplasty using cement and surgery. The therapy is performed under local or general anesthesia with fluoroscopic or computed tomography guidance. A total of 10\u201315 mL of ethanol is slowly injected via unilateral or bilateral pedicles. Complications of the therapy include hypotension and arrhythmia during the procedure, paralysis immediately after the procedure, and delayed compression fractures. This review could enable the refinement of knowledge regarding ethanol sclerosis therapy, which is a treatment option that could be adopted.<\/jats:p>","DOI":"10.3390\/jcm12123926","type":"journal-article","created":{"date-parts":[[2023,6,9]],"date-time":"2023-06-09T02:03:18Z","timestamp":1686276198000},"page":"3926","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Ethanol Sclerosis Therapy for Aggressive Vertebral Hemangioma of the Spine: A Narrative Review"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5025-7259","authenticated-orcid":false,"given":"Juichi","family":"Tonosu","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Kanto Rosai Hospital, Kawasaki 211-8510, Kanagawa, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasuteru","family":"Yamaguchi","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Kanto Rosai Hospital, Kawasaki 211-8510, Kanagawa, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akiro","family":"Higashikawa","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Kanto Rosai Hospital, Kawasaki 211-8510, Kanagawa, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenichi","family":"Watanabe","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Kanto Rosai Hospital, Kawasaki 211-8510, Kanagawa, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,6,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1148\/radiology.161.1.3763864","article-title":"Vertebral hemangiomas: Radiologic evaluation","volume":"161","author":"Laredo","year":"1986","journal-title":"Radiology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1007\/s00256-014-2035-y","article-title":"A systematic approach to vertebral hemangioma","volume":"44","author":"Gaudino","year":"2015","journal-title":"Skelet. Radiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1120","DOI":"10.1177\/21925682221137026","article-title":"Management of Aggressive Vertebral Haemangioma and Assessment of Differentiating Pointers Between Aggressive Vertebral Haemangioma and Metastases\u2014A Systematic Review","volume":"13","author":"Subramaniam","year":"2022","journal-title":"Glob. Spine J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"20140771","DOI":"10.1259\/bjr.20140771","article-title":"Aggressive spinal haemangiomas: Imaging correlates to clinical presentation with analysis of treatment algorithm and clinical outcomes","volume":"88","author":"Cloran","year":"2015","journal-title":"Br. J. Radiol."},{"key":"ref_5","first-page":"E637","article-title":"Single level percutaneous vertebroplasty for vertebral hemangiomata\u2014A review of outcomes","volume":"23","author":"Nambiar","year":"2020","journal-title":"Pain Phys."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1177\/145749691110000210","article-title":"Management of cement vertebroplasty in the treatment of vertebral hemangioma","volume":"100","author":"Boschi","year":"2011","journal-title":"Scand. J. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"E731","DOI":"10.1097\/BRS.0000000000002973","article-title":"Long-term tumor control with radiotherapy for symptomatic hemangioma of a vertebral body","volume":"44","author":"Parekh","year":"2019","journal-title":"Spine"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/S0936-6555(05)80151-7","article-title":"Radiation therapy for symptomatic vertebral haemangioma","volume":"2","author":"Asthana","year":"1990","journal-title":"Clin. Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1016\/S1051-0443(93)71948-X","article-title":"Transarterial embolization of vertebral hemangioma","volume":"4","author":"Smith","year":"1993","journal-title":"J. Vasc. Interv. Radiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"E67","DOI":"10.1097\/BRS.0000000000003192","article-title":"Surgical management of Enneking stage 3 aggressive vertebral hemangiomas with neurological deficit by one-stage posterior total en bloc spondylectomy: A review of 23 cases","volume":"45","author":"Ji","year":"2020","journal-title":"Spine"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1097\/BSD.0b013e3181efe0a4","article-title":"Treatment of Enneking stage 3 aggressive vertebral hemangiomas with intralesional spondylectomy: Report of 10 cases and review of the literature","volume":"24","author":"Acosta","year":"2011","journal-title":"J. Spinal. Disord. Tech."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1056\/NEJM199408253310804","article-title":"Brief report: Relief of spinal cord compression from vertebral hemangioma by intralesional injection of absolute ethanol","volume":"331","author":"Heiss","year":"1994","journal-title":"N. Engl. J. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1016\/j.jocn.2009.10.027","article-title":"Acute hemodynamic instability during alcohol ablation of symptomatic vertebral hemangioma: A prospective study","volume":"17","author":"Yadav","year":"2010","journal-title":"J. Clin. Neurosci."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1577","DOI":"10.1097\/00007632-200107150-00015","article-title":"Efficacy and safety of ethanol injections in 18 cases of vertebral hemangioma: A mean follow-up of 2 years","volume":"26","author":"Bas","year":"2001","journal-title":"Spine"},{"key":"ref_15","first-page":"1091","article-title":"Alcohol ablation of symptomatic vertebral hemangiomas","volume":"20","author":"Goyal","year":"1999","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1148\/radiology.214.2.r00fe46341","article-title":"Symptomatic vertebral hemangiomas: Treatment by means of direct intralesional injection of ethanol","volume":"214","author":"Doppman","year":"2000","journal-title":"Radiology"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2860","DOI":"10.1007\/s00330-016-4664-0","article-title":"Long-term outcome of percutaneous alcohol embolization combined with percutaneous vertebroplasty in aggressive vertebral hemangiomas with epidural extension","volume":"27","author":"Premat","year":"2017","journal-title":"Eur. Radiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1136","DOI":"10.1097\/00029330-200707010-00004","article-title":"Cement vertebroplasty combined with ethanol injection in the treatment of vertebral hemangioma","volume":"120","author":"Chen","year":"2007","journal-title":"Chin. Med. J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/j.spinee.2018.05.015","article-title":"Long-term outcome of treatment of vertebral body hemangiomas with direct ethanol injection and short-segment stabilization","volume":"19","author":"Chandra","year":"2019","journal-title":"Spine J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1007\/s00381-015-2941-x","article-title":"Management of pediatric single-level vertebral hemangiomas presenting with myelopathy by three-pronged approach (ethanol embolization, laminectomy, and instrumentation): A single-institute experience","volume":"32","author":"Singh","year":"2016","journal-title":"Childs Nerv. Syst."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"80","DOI":"10.3171\/SPI-07\/07\/080","article-title":"Lumbar vertebral hemangioma presenting with the acute onset of neurological symptoms. Case report","volume":"7","author":"Chen","year":"2007","journal-title":"J. Neurosurg. Spine"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"502","DOI":"10.4184\/asj.2014.8.4.502","article-title":"Two-stage surgical management of multilevel symptomatic thoracic haemangioma using ethanol and iliac crest bone graft","volume":"8","author":"Degulmadi","year":"2014","journal-title":"Asian Spine J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1016\/j.neurad.2012.10.003","article-title":"Percutaneous ethanol embolization and cement augmentation of aggressive vertebral hemangiomas at two adjacent vertebral levels","volume":"41","author":"Cianfoni","year":"2014","journal-title":"J. Neuroradiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1845","DOI":"10.1097\/00007632-199909010-00015","article-title":"Brown-Sequard syndrome after management of vertebral hemangioma with intralesional alcohol. A case report","volume":"24","author":"Niemeyer","year":"1999","journal-title":"Spine"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"E7","DOI":"10.3171\/2016.5.FOCUS16169","article-title":"Surgical treatment of aggressive vertebral hemangiomas","volume":"41","author":"Vasudeva","year":"2016","journal-title":"Neurosurg. Focus"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/12\/3926\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:50:51Z","timestamp":1760125851000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/12\/3926"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,8]]},"references-count":25,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2023,6]]}},"alternative-id":["jcm12123926"],"URL":"https:\/\/doi.org\/10.3390\/jcm12123926","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,6,8]]}}}