title: Preoperative embolization significantly decreases intraoperative blood loss during palliative surgery for spinal metastasis.
abstract: Several studies have evaluated the efficacy of preoperative embolization in devascularizing tumors. However, no study has measured intraoperative blood loss in a single palliative surgery compared with a control group without preoperative embolization. The purpose of this retrospective study was to evaluate the efficacy of preoperative embolization on intraoperative blood loss in palliative decompression and instrumented surgery using a posterior approach for spinal metastasis. Between 2000 and 2010, forty-six patients underwent palliative decompression and instrumented surgery using a posterior approach for spinal metastasis in the thoracic and lumbar spine. Preoperative embolization was performed in 23 patients (embolization group), and surgery was performed within 3 days after embolization. The embolic materials used were polyvinyl alcohol particles, gelatin sponge, and metallic coils. Twenty-three patients did not undergo embolization (no embolization group). Pain and neurologic symptoms in all 46 patients were relieved postoperatively. Average intraoperative blood loss was 520 mL (range, 140-1380 mL) in the embolization group and 1128 mL (range, 100-3260 mL) in the no embolization group (P<.05). In the embolization group, intraoperative blood loss was not correlated with the degree of tumor vascularization, completeness of embolization, or time between embolization and surgery. Intraoperative blood loss after preoperative embolization was less than half that after no preoperative embolization.
authors.affiliation: Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan. skato323@gmail.com
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kato
authors.forename: Hideki
authors.initials: H
authors.lastname: Murakami
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Minami
authors.forename: Satoru
authors.initials: S
authors.lastname: Demura
authors.forename: Katsuhito
authors.initials: K
authors.lastname: Yoshioka
authors.forename: Osamu
authors.initials: O
authors.lastname: Matsui
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tsuchiya
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D007796:Laminectomy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D019106:Postoperative Hemorrhage / Q000209:etiology* / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000556:secondary* / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult