According to a study presented at the recent American Academy of Orthopaedic Surgeons (AAOS) annual meeting (7-11 February 2012, San Francisco, USA), preoperative transarterial embolization significantly reduces intraoperative blood loss in patients with spinal metastases undergoing palliative posterior decompression and instrumentation surgery.
Satoshi Kato, Department of Orthopedic Surgery, Kanazawa University, Japan and his fellow authors reported that although some studies have investigated the effectiveness of preoperative transarterial embolization in devascularising spinal tumours, none have assessed the effectiveness of transarterial embolization for a single procedure. They wrote in their abstract: “The purpose of this study was to evaluate the effectiveness of preoperative transarterial embolization in palliative posterior decompression and instrumentation surgery for spinal metastasis.”
Kato et al reviewed 45 patients who underwent palliative posterior decompression and instrumentation for spinal metastasis in the thoracolumbar spine between 2000 and 2010. Of these patients, 23 received preoperative transarterial embolization (using gelatin sponge, polyvinyl alcohol foam, and metallic coils) and underwent surgery three days afterwards. Overall, one to three vertebral levels were decompressed by laminectomy and aggressive debulking of vertebral tumour and five to seven levels were stabilised by posterior instrumentation. The most common primary cancer in both groups was lung cancer (seven patients in the embolization group and eight in the non-embolization group).
Intraoperative blood loss was significantly reduced in the embolization groups compared with the non-embolization group: mean 520ml (140–1380ml) vs. 1059ml (100–3260ml), respectively, p
Kato et al concluded: “The intraoperative blood loss, after preoperative transarterial embolization, was measured to be about half of the intraoperative blood loss measured without preoperative transarterial embolization.”
Kato told Spinal News International: “We recommend that preoperative embolization should be done for the metastases for kidney, liver and thyroid, which are well known as being hypervascular. We also recommend that surgery should be done within three days after the embolization.” He explained that in their study, there was no difference in blood loss within 24 hours and more than 24 hours after the embolization.