Vertebral hemangioma is a very common benign tumor of the spine. We call it 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 capillaries or spongy vessels, because pathologically it consists of irregular vascular cavities surrounded by flattened epithelial cells. Vertebral hemangioma is a relatively common benign tumor of the vertebral body, most commonly found in the lower thoracic and upper lumbar spine. 60% of vertebral hemangiomas grow in the thoracic spine, 30% in the lumbar spine, and about 10% in the cervical and sacral spine. The vast majority of hemangiomas are asymptomatic and are discovered by chance during an examination. What is the exact incidence of hemangiomas? The actual number is not known. The data available is that the detection rate at autopsy is 10-12%. In other words, one in ten people will have it on their spine. 1, vertebral hemangioma vertebral hemangioma pathology can be divided into spongy hemangioma and capillary hemangioma, small hemangioma is mostly asymptomatic, a few only limited dull pain, when the lesion is larger can compress the spinal cord and nerve roots and cause the corresponding symptoms. Typical vertebral hemangiomas often involve the vertebral body, and a few lesions may spread into the vertebral arch or the vertebral plate and spinous process. This lesion is most often combined with a lesion in the mid-thoracic spine. Spinal cord compression is less common and arises from a mechanism of fracture of the involved vertebral body with associated soft tissue mass or hematoma formation. Vertebral hemangioma does not deteriorate and is a benign lesion, so please do not worry. Clinical manifestations can develop at any age, and the clinical symptoms are related to the location and growth rate of the tumor. Generally, it is often found by chance without symptoms. If the tumor is located in the spine, a few of them may produce spinal cord or nerve root compression symptoms, and pathological fracture and paraplegia are common complications. However, a small number of hemangiomas may cause localized pain due to swelling and growth, and a smaller number may grow beyond the vertebral body. If the nerve roots are compressed, it may lead to radiating pain in the trunk or limbs; if the spinal cord is compressed, it may lead to limb weakness or even paralysis. On X-ray and CT film, hemangioma often shows characteristic “fence sign”, “honeycomb sign” or “dot sign”, while on MRI, it shows a high signal area with regular T2 boundary. 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 puncture biopsy. There is a risk of bleeding or epidural hematoma with puncture biopsy. 4.Treatment plan Asymptomatic hemangiomas do not require treatment. Radiotherapy and vertebroplasty are available for those with significant local pain. Surgery should be considered only when the tumor invades the spinal canal and causes spinal cord compression and nerve dysfunction. The purpose of surgery is to relieve the nerve compression, and according to the patient’s specific condition, vertebroplasty and other surgical procedures can be chosen.