Comparison of Preoperative Embolization and Local Hemostatic Agents in Surgery of Hypervascular Spinal Tumors
Authors: Zaborovskii Nikita , Ptashnikov Dmitry , Mikhaylov Dmitry , Masevnin Sergei 
Published: May 2015

Introduction

Currently, there is no consensus about how to reduce the intraoperative risk of hemorrhage in spinal decompression surgery of hypervascular spinal tumors, such as aggressive hemangioma, multiple myeloma, plasmacytoma, and metastasis of renal cell carcinoma.

Materials and Methods

A retrospective study of 110 patients operated in our institute was held between 2003 and 2013. There were 69 male and 41 female patients with extradural hypervascular spinal tumor. The study included 61 patients with metastasis of renal cell carcinoma, 27 with multiple myeloma, 15 with plasmacytoma, and 7 with aggressive hemangioma. The first group included 57 patients who underwent preoperative tumor embolization. The second group consisted of 53 patients who were treated surgically using intraoperative local hemostatic agents. We performed two types of treatment options: palliative decompression and total spondylectomy. The first group was divided into two subgroups: 30 patients with palliative decompression (1PD) and 27 with total spondylectomy (1TS). In the second group, there were: 28 patients with palliative decompression (2PD) and 25 with total spondylectomy (2TS). The parameters under evaluation were the blood loss volume, drainage loss, operation time, hemoglobin level, possible complications, and time of hospital stay.

Results

The average intraoperative blood loss for all embolized patients was 1,175 mL (range, 400–1,700 mL) in subgroup 1PD, 3,012 mL (range, 1,750–4,900 mL) in subgroup 1TS and it was slightly less than average in subgroups with local hemostatic agents: 2PD: 1,557 mL (range, 600–2,400 mL), 2TS: 3,262 mL (range, 1,200–5,600 mL). Nevertheless, no statistically significant difference in blood loss volume was found between groups of patients who underwent palliative decompression (p > 0.05). In groups of patients with total spondylectomy, results confirmed a high effectiveness of preoperative embolization, as we did get significant difference ( p < 0.05). Drainage loss was 968 mL (range, 680–1,400 mL) in group 1PD compared with 464 mL (range, 310–660 mL) in group 2PD and 1,223 mL (range, 700–1,780 mL) in group 1TS compared with 983 mL (range, 650–1,900 mL) in group 2TS. Statistically significant difference in the average drainage loss was found between two methods of hemostasis in both subgroups ( p < 0.05). Postoperative hemoglobin level reduce is almost equal in both groups of patients. Postoperative complications were also nearly equal in both the groups, but in group 1PD a patient developed irreversible neurologic deficits after embolization (Frankel D to A). Although preoperative embolization is a relatively safe procedure, there still remains the risk of cord ischemia.

Conclusion

Local hemostatic agents demonstrated a good control of hemorrhage. We did not get evidence that embolization is more effective than using local hemostatic agents for patients with hypervascular spinal tumors who underwent palliative decompression. Operations using embolization proved to be as successful as operations without this expensive, risky procedure. Though, efficiency of embolization for patients with total spondylectomy is significantly better.