Introduction: Hemangioma is the commonest tumor of vertebral body and is seen in 10% of people as an incidental finding but in less than 1% becomes symptomatic. The commonest sign is pain and rarely causes neurological symptom or pathologic fracture.

Case Report: The patient was a 55 year old man with the history of back pain for 2 year and a progressive gait disturbance within 3 weak before admission. Both legs were spastic on ex-amination and an aggressive hemangioma of T7 vertebrae with epidural extension was dis-closed in imaging. He had simultaneously asymptomatic hemangioma of T11. He underwent neoadjuvant embolization and anterior corpectomy and both anterior and posterior fixation. After 3 months the patient’s operative myelopathy symptoms resolved and after one year follow-up he was asymptomatic. Conclusion: Despite the high prevalence of vertebral hemangioma it rarely causes myelopathy and needs surgical treatment.