#164 The Role of Preoperative Vascular Embolization in Surgery for Spinal Metastases
Poster Presented by: N.S. Kumar
N.S. Kumar (1)
B. Tan (1)
P. Gahlot (2)
A.S. Zaw (1)
A. Gopinathan (2)
L. Tan (2)
(1) National University Health System, Orthopaedic Surgery, Singapore, Singapore
(2) National University Health System, Radiology, Singapore, Singapore
Summary: Retrospective analysis of embolized versus non-embolized surgical cases for spinal metastases stratified by primary tumor and type of surgery comparing blood loss (hemoglobin concentration drop, estimated intraoperative loss), length of stay (LOS, days) and duration of surgery (DOS, minutes). Certain embolized groups showed better outcome in LOS and DOS but significant reduction in blood loss was only seen in the myeloma/lymphoma group.
Introduction: Surgical management of spinal metastases involves decompression and fusion procedures. Preoperative embolization of metastatic tumors aims at reducing perioperative blood loss and improving surgical outcome. This study aims to compare the perioperative degree of blood loss and surgical outcome in surgical cases of spinal metastases, comparing embolized and non-embolized cases and stratifying by primary tumor and surgical procedure.
Materials and Methods: This is a retrospective study analyzing patients operated on in a tertiary hospital for spinal metastases over a 5-year period. The population was stratified to cases who underwent pre-operative embolization and those who did not. Cases were then stratified into primary tumor type (Renal, Pulmonary, Colorectal, Lymphoma/Myeloma, Breast and Others), type of surgery (I:Cervical Corpectomy & Stabilization, II:Thoracolumbar Laminectomy/Tumorectomy Decompression & Instrumentation, III:Thoracolumbar Corpectomy & Stabilization) and both. Peri and intraoperative blood loss was quantified by: (1) hemoglobin concentration drop with consideration of blood units transfused (2) estimated blood loss intra-operatively. In addition, LOS and DOS were assessed. Age & Race were also analysed for influence on outcome.
Results: 98 cases were enrolled (36 embolized, 62 non-embolized, median age 60). Analysis revealed that in myeloma/lymphoma cases, embolization resulted in a significant decrease in blood loss (mean difference=1317 ml, p=0.02) and a reduced DOS (94.5 minutes, p=0.04). In colorectal cases, embolization resulted in a reduction in LOS (38.6 days, p=0.04) and DOS (212 minutes, p=0.03). In pulmonary cases, embolization reduced DOS (123.1 minutes, p=0.009). Comparison by type of surgery revealed that embolization reduced the LOS and DOS in type II surgeries (8.42 days, p=0.02; 66.8 minutes, p=0.02) and the DOS in type I surgeries. Combined stratification by tumor and surgery type revealed that embolization is associated with significant reduction in blood loss (2985ml, p< 0.01) in the myeloma patients with type II surgery. Increased age resulted in a borderline significant increase in hemoglobin concentration drop (0.03, p=0.06).
Conclusion: Pre-operative embolization in spinal metastases has shown significant benefits in LOS and DOS in various groups of spinal metastases cases, but its absolute value in reducing blood loss per se may require further extended studies to verify.