Preoperative embolization in surgical treatment of spinal metastases originating from non–hypervascular primary tumors: a propensity score matched study using 495 patients

• Published in: The spine journal 2022-08, Vol.22 (8), p.1334-1344
• Main Authors: Groot, Olivier Q., van Steijn, Nicole J., Ogink, Paul T., Pierik, Robert-Jan, Bongers, Michiel E.R., Zijlstra, Hester, de Groot, Tom M., An, Thomas J., Rabinov, James D., Verlaan, Jorrit-Jan, Schwab, Joseph H.
• Format: Article
• Language: English
• Subjects: Complications; Intraoperative blood loss; Non–hypervascular tumors; Preoperative embolization; Spinal metastases
• ISSN: 1529-9430; 1878-1632
• DOI: 10.1016/j.spinee.2022.03.001

Preoperative embolization (PE) reduces intraoperative blood loss during surgery for spinal metastases of hypervascular primary tumors such as thyroid and renal cell tumors. However, most spinal metastases originate from primary breast, prostate, and lung tumors and it remains unclear whether these and other spinal metastases benefit from PE. To assess the (1) efficacy of PE on the amount of intraoperative blood loss and safety in patients with spinal metastases originating from non–hypervascular primary tumors, and (2) secondary outcomes including perioperative allogeneic blood transfusion, anesthesia time, hospitalization, postoperative complication within 30 days, reoperation, 90-day mortality, and 1-year mortality. Retrospective propensity-score matched, case-control study at 2 academic tertiary medical centers. Patients 18 years of age or older undergoing surgery for spinal metastases originating from primary non–thyroid, non–renal cell, and non–hepatocellular tumors between January 1, 2002 and December 31, 2016 were included. The primary outcomes were estimated amount of intraoperative blood loss and complications attributable to PE, such as neurologic injury, wound infection, thrombosis, or dissection. The secondary outcomes included perioperative allogeneic blood transfusion, anesthesia time, hospitalization, postoperative complication within 30 days, reoperation, 90-day mortality, and 1-year mortality. In total, 495 patients were identified, of which 54 (11%) underwent PE. After propensity score matching on 21 variables, including primary tumor, number of spinal levels, and surgical treatment, 53 non–PE patients were matched to 53 PE patients. Matching was adequate measured by comparing the matched variables, testing the standardized mean differences (