Pre-operative embolisation of spinal metastasis: technique, complication rate and outcome-clinical experience

Pre-operative embolisation of metastatic spinal tumours has the potential to decrease intra-operative blood loss. Intra-operative blood loss is multifactorial and one factor may be the embolisation technique used. The purpose of this study was to retrospectively analyse the effect of three different pre-operative embolisation techniques on intra-operative blood loss, complication rate and tumour aetiology in patients treated with a corpectomy and dorsoventral stabilisation at our institution.

We conducted a retrospective analysis of embolisation procedures for vertebral metastases performed from January 2002 to December 2011. Only pre-operatively embolised patients treated by a single-level hemicorpectomy or corpectomy procedure from T4-L5, including posterior spinal stabilisation using pedicle screws, were included. All patient charts and examinations were analysed regarding the embolisation technique, gender, age, primary tumour, time between the embolisation and surgery, intra-operative blood loss, intra-operative transfusions and complications related to embolisation.

We identified a total of 46 patients, 25 male and 21 female patients. The mean age at the time of surgery was 66 years (range 39-84 years). The tumours treated were: 15 (33%) renal cell carcinomas, six (13%) breast carcinomas, five (11%) lung carcinomas, five (11%) urothelial carcinomas, four (9%) myelomas and 11 (24%) miscellaneous types including rectal carcinoma, thymoma and melanoma. Embolisation with coils was performed in 23 patients, particles were used in six and a combination of coils and particles in 18. The mean time between the embolisation and surgery was 23 hours (range 80-4,430 minutes). The median overall intra-operative estimated blood loss (EBL) was 2,300 ml (range 500-15,000 ml). In patients embolised with coils and particles, EBL was 2,200 ml compared to 1,450 ml in patients embolised with particles and 2,500 ml in the coil group. No statistically significant differences between the three groups could be detected. There were no complications related to the embolisation techniques.

Pre-operative embolisation of spinal metastases using coils, particles or a combination of both is a safe and reproducible procedure. In our cohort we reported no complications during the three different embolisation techniques. No statistically significant difference regarding blood loss between the three embolisation techniques could be detected. Our data confirm existing studies concerning the control of intra-operative blood loss using different embolisation techniques. The benefit of embolisation with a combination of coils and particles compared to embolisation with particles only is questionable.