Preoperative Embolization vs. Local Hemostatic Agents in Spinal Surgery of Hypervascular Metastases

Abstract

Background: 
Currently there is no consensus about how reduce the intraoperative risk of hemorrhage in spinal decompression surgery of hypervascular metastases (HVM) such as renal cell carcinoma, multiple mieloma.
Purpose: 
Compare the effectiveness of using different methods reduce blood loss.
Material and Methods: 
A retrospective study of 58 patients (median age 57 years) operated at our institute between 2001 and 2013. There were 37 male and 21 female patients with extradural HVM (39 with renal cell carcinoma, 19 with multiple mieloma). The metastatic lesions were located in the thoracic spine (n = 45; 77.6%), the lumbar spine (n = 13; 22.4%). We decided to evaluate possible parameters in a surgically homogeneous group of patients with spinal cord compression.
In first group included 30 consecutive patients who underwent preoperative spinal angiography and tumor embolization. The second group consisted of 28 consecutive patients, which were treated surgically with intraoperative using local hemostatic agents (gelatin-thrombin matrix). Each patient underwent a palliative decompression and MISS stabilization with using a posterior approach as the primary surgery for spinal metastasis. The parameters evaluated were the blood loss volume, hemoglobin level, complications. The effectiveness of methods reduce blood loss was analyzed using nonparametric statistical tests.
Results and Discussion: 
In the first group median intraoperative blood loss was 1175 mL (range, 400-1700 mL), preoperative median hemoglobin level was 13.65 g/dL compared with postoperative (on first postoperative day) 10.78 g/dL. One patient developed irreversible neurologic deficits following embolization. Although preoperative embolization is a relatively safe procedure, there remains a risk of cord ischemia.
In the second group median intraoperative blood loss was 1557 mL (range, 600-4000 mL), preoperative median hemoglobin level was 13.32 g/dL compared with postoperative 10.04 g/dL. Between groups, there was no significant difference (P>0.05).
Conclusions: 
We did not get evidence that embolization better than using local hemostatic agents for patients with HVM who underwent palliative decompression and MISS stabilization.

Abstract #104