title: Palliative embolization for metastases of the spine.
abstract: BACKGROUND
  To present palliative selective and superselective arterial embolization with N-butyl-cyanoacrylate for cancer patients with spinal metastases.
  
  
  METHODS
  We studied the files of 164 cancer patients (94 men and 70 women; mean age 57.6 years; range 35-81 years) treated from March 2003 to March 2013 with 178 selective arterial embolization procedures for metastases of the spine from variable primary cancers. We evaluated the technical success of the embolization procedure with post-procedural angiography, the clinical effect in pain relief, need for analgesics and tumor size reduction, and the embolization-related complications.
  
  
  RESULTS
  Post-embolization angiography showed complete occlusion of the pathological feeding vessels in all procedures. Pain score and need for analgesics reduced by 50 % in 159 patients (97 %); no response was achieved in five patients with metastases of the sacrum. The mean duration of pain relief was 9.2 months (range 1-12 months). Metastatic tumor size reduced from a mean of 5.5 cm (range 3.5-7.5 cm) pre-embolization to a mean of 4.5 cm (range 3-5 cm) at the 6-month follow-up; the difference was not statistically significant. Ninety-three patients (56.7 %) experienced embolization-related complications the most common being post-embolization syndrome (80 patients, 48.8 %) followed by leg paresthesias (ten patients, 6 %), and rupture of a lumbar artery (one patient, 0.6 %).
  
  
  CONCLUSIONS
  Selective arterial embolization with N-butyl-cyanoacrylate should be considered for pain palliation of patients with metastases of the spine. However, pain relief is temporary, and complications, although minor may occur.
authors.affiliation: Department of Diagnostic and Interventional Radiology, Istituto Ortopedico Rizzoli, Bologna, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Facchini
authors.affiliation: Department of Oncology, Saint Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Di Tullio
authors.affiliation: Department of Diagnostic and Interventional Radiology, Istituto Ortopedico Rizzoli, Bologna, Italy.
authors.forename: Milva
authors.initials: M
authors.lastname: Battaglia
authors.affiliation: Poliambulatorio Zappi-Bartalena, Imola, Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Bartalena
authors.affiliation: Department of Diagnostic and Interventional Radiology, Istituto Ortopedico Rizzoli, Bologna, Italy.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Tetta
authors.affiliation: Department of Orthopaedics, Istituto Ortopedico Rizzoli, Bologna, Italy.
authors.forename: Costantino
authors.initials: C
authors.lastname: Errani
authors.affiliation: First Department of Orthopaedics, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece. afm@otenet.gr.
authors.forename: Andreas F
authors.initials: AF
authors.lastname: Mavrogenis
authors.affiliation: Department of Interventional Angiographic Radiology, Istituto Ortopedico Rizzoli, Bologna, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Rossi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016461:Chemoembolization, Therapeutic / Q000379:methods; D004659:Enbucrilate / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods; D013125:Spinal Neoplasms / Q000556:secondary* / Q000628:therapy; D014014:Tissue Adhesives / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D014014:Tissue Adhesives; D004659:Enbucrilate
keywords: Embolization; Metastasis; Pain; Palliation; Spine