The Role of Preoperative Vascular Embolization in Surgery for Metastatic Spinal Tumours

Overview

Journal Eur Spine J

Specialty Orthopedics

Date 2016 Mar 13

PMID 26968873

Citations 14

Authors

Naresh Kumar

Barry Tan

Aye Sandar Zaw

Hnin Ei Khine

Karthikeyan Maharajan

Leok Lim Lau

Prapul Chander Rajendran

Anil Gopinathan

Affiliations

Soon will be listed here.

Abstract

Purpose: To determine the effect of preoperative embolization on intraoperative blood loss in surgery for metastatic spinal tumours stratified by tumour type, type of surgical approach and extent of surgery.

Methods: We retrospectively analysed 218 patients undergoing open surgery for metastatic spine tumours in our institution between 2005 and 2014. The cohort was divided to those who underwent preoperative embolization and those who did not. The patients were further stratified into different subgroups by tumour types, types of surgical procedure, levels of instrumentation and levels of decompression. Estimated blood loss, duration of surgery and length of hospital stay were compared between embolized and non-embolized cases in each subgroup. The impact of embolization extent, the time gap between embolization and index surgery on blood loss were also studied.

Results: Preoperative embolization was performed in 45 out of 218 patients. Non-embolized cases had insignificantly lesser blood loss and shorter duration of surgery compared to embolized cases in all subgroups. Embolization, however, conferred reduction in length of hospital stay in some of the subgroups, yet the differences were not significant. The patients who achieved total embolization bled less than those who achieved subtotal or partial embolization. The effectiveness of the embolization procedure in reducing intraoperative blood loss was found to be profound when the gap between embolization and surgery was within 24 h.

Conclusions: Our study demonstrated that success of embolization in reducing blood loss depends on the extent of embolization and time interval between embolization and index surgery.

Citing Articles

Does Intraoperative Cell-Salvaged Autologous Blood Transfusion in Metastatic Spine Tumour Surgery Impact Clinical Outcomes: A Prospective Clinical Study With 4-year Follow-Up.

Kumar N, Hui S, Chan Y, Tan Y, Jeyachandran P, Kumar L Global Spine J. 2025; :21925682251319760.

PMID: 39946653 PMC: 11826825. DOI: 10.1177/21925682251319760.

Answer to the letter to the editor concerning "Current state of preoperative embolization for spinal metastasis - A survey by the EANS spine section".

Motov S, Stengel F, Ringel F, Bozinov O, Stienen M Brain Spine. 2025; 5():104160.

PMID: 39810927 PMC: 11732059. DOI: 10.1016/j.bas.2024.104160.

Injectable Nanorobot-Hydrogel Superstructure for Hemostasis and Anticancer Therapy of Spinal Metastasis.

Chen Q, Yan M, Hu A, Liang B, Lu H, Zhou L Nanomicro Lett. 2024; 16(1):259.

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Current state of preoperative embolization for spinal metastasis - A survey by the EANS spine section.

Motov S, Stengel F, Ringel F, Bozinov O, Stienen M Brain Spine. 2023; 3:102712.

PMID: 38021014 PMC: 10668085. DOI: 10.1016/j.bas.2023.102712.

The Optimal Time between Embolization and Surgery for Hypervascular Spinal Metastatic Tumors : A Systematic Review and Meta-Analysis.

Yuh W, Han J, Lee C, Kim C, Kang H, Chung C J Korean Neurosurg Soc. 2023; 66(4):438-445.

PMID: 37315576 PMC: 10323269. DOI: 10.3340/jkns.2022.0204.

References

Bowers T, Murray J, Charnsangavej C, Soo C, Chuang V, Wallace S . Bone metastases from renal carcinoma. The preoperative use of transcatheter arterial occlusion. J Bone Joint Surg Am. 1982; 64(5):749-54. View

Pikis S, Itshayek E, Barzilay Y, Hasharoni A, Kaplan L, Gomori M . Preoperative embolization of hypervascular spinal tumors: current practice and center experience. Neurol Res. 2014; 36(6):502-9. DOI: 10.1179/1743132814Y.0000000361. View

GOLDSTEIN H, Medellin H, Ben-Menachem Y, Wallace S . Transcatheter arterial embolization in the management of bleeding in the cancer patient. Radiology. 1975; 115(3):603-8. DOI: 10.1148/15.3.603. View

Chatziioannou A, Johnson M, Pneumaticos S, LAWRENCE D, Carrasco C . Preoperative embolization of bone metastases from renal cell carcinoma. Eur Radiol. 2000; 10(4):593-6. DOI: 10.1007/s003300050969. View

Field-Smith A, Morgan G, Davies F . Bortezomib (Velcadetrade mark) in the Treatment of Multiple Myeloma. Ther Clin Risk Manag. 2008; 2(3):271-9. PMC: 1936263. DOI: 10.2147/tcrm.2006.2.3.271. View

Rehak S, Krajina A, Ungermann L, Ryska P, Cerny V, Talab R . The role of embolization in radical surgery of renal cell carcinoma spinal metastases. Acta Neurochir (Wien). 2008; 150(11):1177-81. DOI: 10.1007/s00701-008-0031-5. View

Kato S, Hozumi T, Takaki Y, Yamakawa K, Goto T, Kondo T . Optimal schedule of preoperative embolization for spinal metastasis surgery. Spine (Phila Pa 1976). 2013; 38(22):1964-9. DOI: 10.1097/BRS.0b013e3182a46576. View

Choi D, Crockard A, Bunger C, Harms J, Kawahara N, Mazel C . Review of metastatic spine tumour classification and indications for surgery: the consensus statement of the Global Spine Tumour Study Group. Eur Spine J. 2009; 19(2):215-22. PMC: 2899817. DOI: 10.1007/s00586-009-1252-x. View

Jacobs W, Perrin R . Evaluation and treatment of spinal metastases: an overview. Neurosurg Focus. 2006; 11(6):e10. DOI: 10.3171/foc.2001.11.6.11. View

10.

Schmidt R, Rupp-Heim G, Dammann F, Ulrich C, Nothwang J . Surgical therapy of vertebral metastases. Are there predictive parameters for intraoperative excessive blood loss despite preoperative embolization?. Tumori. 2011; 97(1):66-73. DOI: 10.1177/030089161109700113. View

11.

Hess T, Kramann B, Schmidt E, Rupp S . Use of preoperative vascular embolisation in spinal metastasis resection. Arch Orthop Trauma Surg. 1997; 116(5):279-82. DOI: 10.1007/BF00390053. View

12.

Berkefeld J, Scale D, Kirchner J, Heinrich T, KOLLATH J . Hypervascular spinal tumors: influence of the embolization technique on perioperative hemorrhage. AJNR Am J Neuroradiol. 1999; 20(5):757-63. PMC: 7056167. View

13.

Guzman R, Dubach-Schwizer S, Heini P, Lovblad K, Kalbermatten D, Schroth G . Preoperative transarterial embolization of vertebral metastases. Eur Spine J. 2004; 14(3):263-8. PMC: 3476739. DOI: 10.1007/s00586-004-0757-6. View

14.

Oppermann J, Bredow J, Siewe J, Eysel P, Koy T . Hypervascular cervical spine metastases: embolization by direct injection of Onyx-18. Eur Spine J. 2015; 24 Suppl 4:S580-4. DOI: 10.1007/s00586-014-3754-4. View

15.

Wilson M, Cooke D, Ghodke B, Mirza S . Retrospective analysis of preoperative embolization of spinal tumors. AJNR Am J Neuroradiol. 2009; 31(4):656-60. PMC: 7964229. DOI: 10.3174/ajnr.A1899. View

16.

Witham T, Khavkin Y, Gallia G, Wolinsky J, Ziya L Gokaslan . Surgery insight: current management of epidural spinal cord compression from metastatic spine disease. Nat Clin Pract Neurol. 2006; 2(2):87-94. DOI: 10.1038/ncpneuro0116. View

17.

Roscoe M, McBroom R, St Louis E, Grossman H, Perrin R . Preoperative embolization in the treatment of osseous metastases from renal cell carcinoma. Clin Orthop Relat Res. 1989; (238):302-7. View

18.

Sciubba D, Petteys R, Dekutoski M, Fisher C, Fehlings M, Ondra S . Diagnosis and management of metastatic spine disease. A review. J Neurosurg Spine. 2010; 13(1):94-108. DOI: 10.3171/2010.3.SPINE09202. View

19.

Robial N, Charles Y, Bogorin I, Godet J, Beaujeux R, Boujan F . Is preoperative embolization a prerequisite for spinal metastases surgical management?. Orthop Traumatol Surg Res. 2012; 98(5):536-42. DOI: 10.1016/j.otsr.2012.03.008. View

20.

Quraishi N, Purushothamdas S, Manoharan S, Arealis G, Lenthall R, Grevitt M . Outcome of embolised vascular metastatic renal cell tumours causing spinal cord compression. Eur Spine J. 2013; 22 Suppl 1:S27-32. PMC: 3578518. DOI: 10.1007/s00586-012-2648-6. View