Effectiveness of Preoperative Embolization in Patients with Spinal Metastases: A Systematic Review and Meta-Analysis

• Published in: World neurosurgery 2021-08, Vol.152, p.e745-e757
• Main Authors: Gao, Zhong-yu, Zhang, Tao, Zhang, Hui, Pang, Cheng-gang, Xia, Qun
• Format: Article
• Language: English
• Subjects: Blood loss; Meta-analysis; Preoperative embolization; Spinal metastasis
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2021.06.062

Debate on the effectiveness of preoperative embolization for spinal metastatic lesions, especially for nonhypervascular tumors, has persisted. The present study aimed to identify the effectiveness of preoperative embolization in patients who had undergone surgery for spinal metastasis. Two of us (Z.T. and Z.H.) independently searched the PubMed, Embase, and Cochrane Central Register of Controlled Trials databases to identify eligible clinical studies that had compared the outcomes of patients treated surgically for spinal metastatic disease with or without preoperative embolization. The primary outcomes included intraoperative blood loss, perioperative blood loss, and transfusion requirements. The secondary outcomes include the operative time, overall survival, and complication rates. Meta-analyses were performed for subgroups of hypervascular, nonhypervascular, and mixed tumors. A fixed effects model was applied when I2 was 50%. A total of 12 studies (1 randomized controlled trial and 11 retrospective case-control studies), with 744 patients, were included. Significantly less intraoperative blood loss (mean difference [MD], −1171.49 mL; 95% confidence interval [CI], −2283.10 to −59.88; P = 0.039), fewer blood transfusions (MD, −3.13 U; 95% CI, −4.86 to −1.39; P