Most lumbar hemangiomas are discovered unintentionally, such as lumbar spine pain and trauma radiographs. If the lumbar hemangioma does not produce symptoms, no treatment is needed and most can be treated conservatively. A small number of lumbar hemangiomas that cause damage to the vertebral structure and do not cause serious complications can be treated with minimally invasive surgery, percutaneous vertebroplasty, cement filling, and strengthening of the affected vertebrae. If the vertebral body has produced a pathologic fracture that causes peripheral compression, open surgery is required to decompress the compressed nerves and spinal cord, perform vertebral body strengthening, pedicle screw fixation, and then treat accordingly.