Preoperative embolization in surgical treatment of spinal mets shows no improvement in intraoperative blood loss

Researchers from Denmark performed a prospective study evaluating the clinical efficacy of preoperative embolization of spinal mets undergoing spinal decompression. Researchers evaluated intraoperative blood loss, rate of transfusion with pRBCs, and operative time. No significant difference in intraoperative blood loss or pRBC transfusion was detected when comparing embolization versus non-embolization groups. There was, however, a significant reduction in operative time. Interestingly, inclusion criteria did not include hypervascularity of the tumor and sub-group analysis demonstrated a statistically significant reduction in blood loss when comparing hypervascular tumors. While the difference in blood loss was less than 500 mL and not considered to be clinically significant as no significant change in transfusion rate was detected.

Comment:

While the manuscript makes a convincing argument that preoperative embolization in patients undergoing spinal decompression does not produce clinically significant results, many questions remain unanswered. Given the subgroup analysis, one could argue that pre-operative embolization of hypervascular tumors may still improve clinical outcomes. However, criteria for determining vascularity was objective and not dependent on tumor type. If your current practice involves pre-operative embolization of hypervascular spinal mets, further research may be warranted before you decide to stop offering that service.


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Grading scale of hypervascularity. (a) Tumor blush equaling no hypervascularity (grade 0). Supply to the anterior spinal artery is present (arrow). (b) Tumor blush equaling moderate hypervascularity of a metastasis (grade 2). (c) Preoperative angiogram showing tumor blush equaling pronounced hypervascularity of a metastasis (grade 3).


Citation: Clausen, C. et al. Preoperative Embolization in Surgical Treatment of Spinal Metastases: Single-Blind, Randomized Controlled Clinical Trial of Efficacy in Decreasing Intraoperative Blood Loss. Journal of Vascular and Interventional Radiology (2015). doi:10.1016/j.jvir.2014.11.014


Post Author: Luke Wilkins, MD