Introduction: The goal of pre-operative embolization of spinal tumors is to improve surgical outcomes by diminishing the vascular flow of the tumor. It is expected that this reduces intra-operative blood loss and operative time. However, there is a paucity of literature evaluating the safety and efficacy of spinal tumor embolization. We report our institutional experience with spinal tumor embolization.
Methods: A retrospective analysis of available clinical charts and angiograms between 2001-2012 were reviewed. Historical patient angiograms were used to calculate percentage of embolization achieved, and relevant clinical and operative data were collected and analyzed.
Results: 50 patients (32 males and 18 females) underwent spinal angiograms at our institution between 2001-2012, clinical data was available on 48 patients. 37 patients underwent pre-operative spinal tumor embolization (24 metastatic and 13 primary lesions), 13 patients underwent spinal angiogram with no evidence of significant tumor blush. The most common spinal lesion was metastatic renal cell (n=16) followed by metastatic follicular cell of the thyroid(n=4). There were no complications due to endovascular embolization, the average estimated blood loss (EBL) during surgery was 1827.27 (ml) and 2.4 (units) of blood transfusions were required, the average operative time was 325 minutes. Following embolization, tumor blush was reduced by 81% on average (cervical 80.0%, thoracic 78.9% and sacral 82.8%). Tumors involving multiple spinal levels were not associated with a statistically significant increase in EBL compared to tumors involving only one spinal level (1947.22 vs 1683.33ml p=.614). Average pre-and post-operative mRS were 2.10 and 1.36 (p=.026) respectively.
Conclusions: Spinal tumor embolization is a safe procedure that is associated with few complications and may improve surgical outcomes by improving extent of resection, limiting intraoperative blood loss, and reducing operative time.
Patient Care: Increases awareness of the clinical utility of pre-operative spinal tumor emoblization.
Learning Objectives: 1. Understand the epidemiology of spinal column metastasis.
2. Understand the potential complication associated with spinal tumor embolization.
3. Understand the factors that may influence the degree of embolization including tumor type, and anatomical location.