Vascular metastatic lesions of the spine: preoperative embolization

Preoperative embolization of vascular metastatic tumors of the spine, particularly carcinomas of renal and thyroid origin, is an adjuvant technique that significantly decreases the intraoperative blood loss and resultant surgical morbidity. Surgical decompression was achieved in 24 spinal vascular metastatic lesions, 20 of which were treated with preoperative embolization and four of which were not. The embolic materials used were gelatin sponge, polyvinyl alcohol foams, and metallic coils. In patients who underwent adequate embolization, an average of 1,850 mL of estimated blood loss was reported; in those who underwent inadequate or no embolization, greater than 3,500 mL of estimated blood loss occurred. When gelatin sponge is used, surgery should be performed within 24 hours to prevent preoperative recanalization.