Practice Pearl: a Novel Use of Transdermal Nitroglycerine To Reduce Blood Transfusion for Surgery of Metastatic Tumors of the Spine

Excerpt

Currently, over 1.4 million new cases of cancer are diagnosed annually in the United States, with roughly 500,000 of these patients dying from metastatic disease per year. Metastases to the pulmonary and hepatic systems are the most frequent, followed by metastases to the skeletal system, of which the spinal column is the most common site. Interestingly, studies on cadavers have shown that as many as 30–90% of patients with terminal cancer have metastatic disease in the spine. It is estimated that approximately 10% of cancer patients develop symptomatic spinal secondaries, but as survival rates for many cancers improve, the prevalence of spinal metastases is likely to increase. Patients with primary or secondary malignant disease of the vertebral column and spinal cord are more often being considered for surgery, the aims of which are primarily to relieve pain but also to excise the lesion, prevent further neurological deterioration, and stabilize the vertebral column.1,2,3 …