Spinal hemangioma is a very common benign tumor of the spine that we call a “tumor”, but in fact it is more appropriately described as a disorder of vascular growth. It is a tumor-like proliferation of blood vessels and endothelial tissue in the bone, either capillary or spongy, because pathologically it consists of irregular vascular cavities surrounded by flattened epithelial cells. Sixty percent of spinal hemangiomas grow in the thoracic spine, 30% in the lumbar spine, and about 10% in the cervical spine and sacrum. The vast majority of hemangiomas are asymptomatic and are discovered incidentally during an examination. For example, some patients have a CT or MRI for low back pain and find out which vertebral hemangioma is written on the report. However, the pain is actually not caused by this hemangioma, but by pain in the lumbar intervertebral discs, small lumbar articular prominences or muscle soft tissues. Just how high is the incidence of hemangioma? The actual value is not clear. The data available is that the detection rate in autopsies is 10-12%. That means that one in ten people will have it on their spine. However, there are a few hemangiomas that produce localized pain due to swelling and growth, and an even smaller number that grow beyond the vertebral body, causing radiating pain in the trunk or limbs if they compress a nerve root, or weakness or even paralysis if they compress the spinal cord. On X-ray and CT, hemangiomas often show a characteristic “fence sign”, “honeycomb sign” or “dot sign”, while on MRI, they appear as high signal areas with regular T2 borders. These tests are often sufficient to establish the diagnosis of hemangioma. Sometimes hemangiomas need to be differentiated from other tumors, and this is done by CT-guided aspiration biopsy. Puncture biopsy carries the risk of bleeding or causing an epidural hematoma.