Purpose: A rare subset of vertebral haemangiomas present aggressively, characterized by significant osseous expansion and extraosseous extension. Particularly in the case of multiple lesions, they present a diagnostic challenge due to the radiological similarity to malignant lesions. We present a case of multiple osseous haemangiomas including three in the vertebrae causing cord compression and radiculopathy, successfully treated via both endovascular and surgical means. Methodology: Prospective Review Results: A 55-year-old female presented with radicular lower back pain. CT and MRI of the spine demonstrated multi-level vertebral body lytic lesions with cord compression at the T12 vertebral level, and extraspinal lesions in the ribs, manubrium, pelvic bones and femur. The patient underwent a T11 to L1 posterior decompression and instrumented fixation, then further endovascular angioembolization of an L5 vertebral lesion that was causing radiculopathy and progressive canal stenosis. Histopathology confirmed a haemangioma. At 1-month follow-up, the patient’s pain had largely resolved and had improving right sided L5 distribution paraesthesia. Conclusion: Cases of multiple aggressive vertebral haemangiomas often present a diagnostic dilemma due to their similarity to malignancy. In cases of multifocal dissemination of haemangiomatous lesions, the extremely rare condition cystic angiomatosis should be considered as a differential. Surgical treatment is indicated in lesions causing myelopathy, and endovascular embolization can be considered either as primary therapy for the lesion or pre-operatively to reduce bleeding risk.