Infantile hemangiomas over the skin on the center lower back/buttock area (lumbosacral area) carry a risk for being associated with a spinal cord problem. A tethered spinal cord is one such abnormality in which the spinal cord is abnormally stretched and anchored to the spinal canal with reduced mobility. Often, there are no symptoms until adulthood, but it can become apparent during childhood. If the spinal cord abnormality is present, over time this condition can lead to problems including neurological damage. Common symptoms are lower back pain, pain and weakness of the legs, walking problems, and loss of control of the bladder and bowel. If your child has a hemangioma in this location, see your doctor to discuss whether imaging the spine for this possibility may be appropriate.
This patient’s hemangioma did not require treatment, however many infants with infantile hemangiomas in this area require treatment if there is ulceration (skin breakdown), hemangioma extends into the buttock crease (just below this hemangioma)/ around the anus and hemangioma has excessive growth.
Related HIG Research
The HIG prospectively evaluated a group of patients with infantile hemangioma (IH) in the midline lumbosacral region for spinal anomalies to determine the risk of spinal anomalies and to make evidence-based recommendations for screening.
Results: 21/41 study participants with a lumbosacral IH had intraspinal abnormalities detected. The relative risk for all patients with lumbosacral IHs for spinal anomalies was 640 (95% CI: 404 – 954) and the positive predictive value of IH for spinal dysraphism was 51.2%. Ulceration of the hemangioma was associated with a higher risk of having spinal anomalies. The presence of additional cutaneous anomalies also was associated with a higher likelihood of finding spinal anomalies; however, 35% of the infants with isolated lumbosacral IHs had spinal anomalies with a relative risk of 438 (95% CI: 188 – 846).
Conclusions: Infants and children with midline lumbosacral IHs are at increased risk for spinal anomalies. Screening magnetic resonance imaging is recommended for children with these lesions.
Drolet BA, Chamlin SL, Garzon MC, Adams D, Baselga E, Haggstrom AN, Holland KE, Horii KA, Juern A, Lucky AW, Mancini AJ, McCuaig C, Metry DW, Morel KD, Newell BD, Nopper AJ, Powell J, Frieden IJ, A Prospective Study of Spinal Anomalies in Children with Infantile Hemangiomas of the Lumbosacral Skin. J Pediatr 2010 Nov;157(5):789-94.