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  • Minimizing Blood Loss with Novel Percutaneous Vertebroplasty Prior to Corpectomy for Vascular Spinal Tumors: A Case Series

    Final Number:

    Radmehr Torabi MD, BS; Joseph Carnevale; David Choi MD; Mahesh V Jayaraman MD; Ryan A. McTaggart MD; Ziya L. Gokaslan MD; Adetokunbo A. Oyelese MD, PhD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2016 Annual Meeting

    Introduction: Surgical resection of hypervascular spinal tumors is often accompanied by significant intraoperative blood loss. The current literature supports superselective angiography and preoperative embolization prior to operative resection. Although these adjuvant therapies have significantly reduced intraoperative blood loss, current literature still reports an average of 2.1 L of blood loss despite today’s standard therapy[1-7]. In an effort to reduce blood loss and subsequent complications, this case series introduces novel percutaneous vertebroplasty (NPV), in addition to embolization, as a means to curtail blood loss during corpectomy for vascular spinal tumors.

    Methods: The authors performed a retrospective review of six patients who underwent NPV with or without feeding artery embolization prior to partial or complete corpectomy for the resection of vascular spine tumors at one institution from December 2013 to February 2016. Blood loss was measured for each patient and compared to the literature for those who underwent standard arterial embolization prior to surgery.

    Results: Six patients underwent NPV, five renal cell carcinoma and one patient with hemangioma. Complete corpectomy was planned in four of the six patients, while the remaining two underwent partial corpectomies. All patients received standard embolization prior to surgery. There was one vascular injury during an anterior approach and this patient was excluded from the analysis. The mean estimated blood loss for five patients was 1180 mL, with only one multi-level (T6-T8) case requiring blood transfusion (8 L). For the single-level corpectomies, the estimated blood loss ranged from 50 to 3900 mL with a mean of 500 mL. Of those in whom single-level corpectomy was planned, one patient required lumbar corpectomy with blood loss of 100 mL and three required thoracic corpectomies with mean blood loss of 633 mL.

    Conclusions: Percutaneous vertebroplasty prior to spinal tumor removal provides acceptable results, holds the potential to reduce operative blood loss and resultant surgical morbidity.

    Patient Care: Our research aims to both highlight the need for further blood loss prevention during corpectomy for vascular spinal tumors and introduce preoperative percutaneous vertebroplasty to address this need.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Understand the significance of vascular spinal tumors and associated surgical complications, including blood loss; 2) Identify current preoperative blood loss prevention methods and the need for advancement; and 3) Discuss the benefits of preoperative percutaneous vertebroplasty to further curtail intraoperative blood loss.

    References: 1. Gellad FE, Sadato N, Numaguchi Y, Levine AM. Vascular metastatic lesions of the spine: preoperative embolization. Radiology. 1990;176(3):683-686. 2. Breslau J, Eskridge JM. Preoperative embolization of spinal tumors. J. Vasc. Interv. Radiol. 1995;6(6):871-875. 3. Manke C, Bretschneider T, Lenhart M, et al. Spinal metastases from renal cell carcinoma: effect of preoperative particle embolization on intraoperative blood loss. Am. J. Neuroradiol. 2001;22(5):997-1003. 4. Chen Y, Tai B, Nayak D, et al. Blood loss in spinal tumour surgery and surgery for metastatic spinal disease A meta-analysis. Bone & Joint Journal. 2013;95(5):683-688. 5. Wang JC, Boland P, Mitra N, et al. Single-stage posterolateral transpedicular approach for resection of epidural metastatic spine tumors involving the vertebral body with circumferential reconstruction: results in 140 patients: invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004. J. Neurosurg. Spine. 2004;1(3):287-298. 6. Olerud C, Jónsson H, Löfberg A-M, Lörelius L-E, Sjöström L. Embolization of spinal metastases reduces peroperative blood loss: 21 patients operated on for renal cell carcinoma. Acta Orthop. Scand. 1993;64(1):9-12. 7. Awad A-W, Almefty KK, Ducruet AF, et al. The efficacy and risks of preoperative embolization of spinal tumors. J. Neurointerv. Surg. 2015:neurintsurg-2015-011833.

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