Top

European Journal of Orthopaedic Surgery & Traumatology

Published in:

01-08-2018 | Original Article • SPINE - METASTASES

Preoperative embolization and local hemostatic agents in palliative decompression surgery for spinal metastases of renal cell carcinoma

Authors: Nikita Zaborovskii, Dmitrii Ptashnikov, Dmitrii Mikaylov, Sergei Masevnin, Oleg Smekalenkov

Published in: European Journal of Orthopaedic Surgery & Traumatology | Issue 6/2018

Abstract

Background

Intraoperative hemorrhage can sometimes be massive in patients with spinal metastasis of renal cell carcinoma (MRCC). Preoperative embolization and local hemostatic agents are routinely use in spinal tumor surgery, but there have been no comparisons between these methods. This report compares the efficiency of various methods of bleeding control and their influence on outcome and survival after decompression procedures for MRCC.

Materials and methods

This was a retrospective case–control study of 54 patients with hypervascular extraosseous MRCC. All patients underwent palliative decompression procedures. We compared two groups of patients stratified by methods of bleeding control. The first group (EMB) included 32 patients who underwent preoperative embolization of a tumor. The second group (HEM) consisted of 22 patients, treated surgically using intraoperative local hemostatic agents. The parameters under evaluation were blood loss volume, drainage loss, possible complications, time of hospital stay and survival.

Results

The median intraoperative blood loss for EMB group [1275 (95% CI 1175–1500) mL] was slightly less than the median in HEM group [1400 (95% CI 1050–1725) mL] without significant differences (p = 0.681). The postoperative drainage loss in HEM group [250 (95% CI 140–325) mL] was significantly less than that in EMB group [500 (95% CI 425–550) mL] (p = 0.013). The complication rate (infections, hematomas, neurological deficit) was nearly equal in all groups. No statistically significant difference in overall survival was found between groups: EMB—26 months (1 year—93.3%, 3 years—26.7%) and HEM—24 months (1 year—95.2%, 3 years—16.3%) (p = 0.360).

Conclusion

Our results suggest that not all patients with MRCC require preoperative embolization, because usage of modern hemostatic agents can be an alternative bleeding control method.

Sciubba DM, Petteys RJ, Dekutoski MB et al (2010) Diagnosis and management of metastatic spine disease. J Neurosurg Spine 13:94–108. https://doi.org/10.3171/2010.3.SPINE09202 CrossRefPubMed

Szpalski M, Gunzburg R, Sztern B (2005) An overview of blood-sparing techniques used in spine surgery during the perioperative period. Haemost Spine Surg 13:18–27. https://doi.org/10.1007/3-540-27394-8_4 CrossRef

Chivukula S, Weiner G, Engh J (2014) The early days of hemostasis in neurosurgery. Neurosurg Focus 36:1–5. https://doi.org/10.3171/2014.1.FOCUS13565 CrossRef

Wilson MA, Cooke DL, Ghodke B, Mirza SK (2010) Retrospective analysis of preoperative embolization of spinal tumors. Am J Neuroradiol 31:656–660. https://doi.org/10.3174/ajnr.A1899 CrossRefPubMed

Thiex R, Harris MB, Sides C et al (2013) The role of preoperative transarterial embolization in spinal tumors. A large single-center experience. Spine J 13:141–149. https://doi.org/10.1016/j.spinee.2012.10.031 CrossRefPubMed

Pikis S, Itshayek E, Barzilay Y et al (2014) Preoperative embolization of hypervascular spinal tumors: current practice and center experience. Neurol Res 36:502–509. https://doi.org/10.1179/1743132814Y.0000000361 CrossRefPubMed

Renkens KL, Payner TD, Leipzig TJ et al (2001) A multicenter, prospective, randomized trial evaluating a new hemostatic agent for spinal surgery. Spine (Phila Pa 1976) 26:1645–1650CrossRef

Schonauer C, Tessitore E, Moraci A et al (2005) The use of local agents: bone wax, gelatin, collagen, oxidized cellulose. Haemost Spine Surg 13:89–96. https://doi.org/10.1007/3-540-27394-8_15 CrossRef

Sabel M, Stummer W (2004) The use of local agents: Surgicel and Surgifoam. Eur Spine J 13(Suppl 1):S97–S101. https://doi.org/10.1007/s00586-004-0735-z CrossRefPubMedPubMedCentral

10.

Olerud C, Jónsson H, Löfberg AM et al (1993) Embolization of spinal metastases reduces peroperative blood loss. 21 patients operated on for renal cell carcinoma. Acta Orthop Scand 64:9–12. https://doi.org/10.3109/17453679308994517 CrossRefPubMed

11.

Guzman R, Dubach-Schwizer S, Heini P et al (2005) Preoperative transarterial embolization of vertebral metastases. Eur Spine J 14:263–268. https://doi.org/10.1007/s00586-004-0757-6 CrossRefPubMed

12.

Kobayashi K, Ozkan E, Tam A et al (2012) Preoperative embolization of spinal tumors: variables affecting intraoperative blood loss after embolization. Acta Radiol 53:935–942. https://doi.org/10.1258/ar.2012.120314 CrossRefPubMed

13.

Kato S, Murakami H, Minami T et al (2012) Preoperative embolization significantly decreases intraoperative blood loss during palliative surgery for spinal metastasis. Orthopedics 35:e1389–e1395. https://doi.org/10.3928/01477447-20120822-27 CrossRefPubMed

14.

Schmidt R, Rupp-Heim G, Dammann F et al (2011) Surgical therapy of vertebral metastases. Are there predictive parameters for intraoperative excessive blood loss despite preoperative embolization? Tumori 97:66–73. https://doi.org/10.1700/611.7141 CrossRefPubMed

15.

Clausen C, Dahl B, Frevert SC et al (2015) Preoperative embolization in surgical treatment of spinal metastases: single-blind, randomized controlled clinical trial of efficacy in decreasing intraoperative blood loss. J Vasc Interv Radiol 26:402–412. https://doi.org/10.1016/j.jvir.2014.11.014 CrossRefPubMed

16.

Perry JW, Montgomerie JZ, Swank S et al (1997) Wound infections following spinal fusion with posterior segmental spinal instrumentation. Clin Infect Dis 24:558–561. https://doi.org/10.1093/clind/24.4.558 CrossRefPubMed

17.

Xing D, Ma J-X, Ma X-L et al (2013) A methodological, systematic review of evidence-based independent risk factors for surgical site infections after spinal surgery. Eur Spine J 22:605–615. https://doi.org/10.1007/s00586-012-2514-6 CrossRefPubMed

18.

Kato S, Hozumi T, Takaki Y et al (2013) Optimal schedule of preoperative embolization for spinal metastasis surgery. Spine (Phila Pa 1976) 38:1964–1969. https://doi.org/10.1097/brs.0b013e3182a46576 CrossRef

19.

Cernoch P, Hechelhammer L, von Hessling A et al (2015) Pre-operative embolisation of spinal metastasis: technique, complication rate and outcome—clinical experience. Int Orthop 39:1399–1404. https://doi.org/10.1007/s00264-015-2769-8 CrossRefPubMed

20.

Fujimaki Y, Kawahara N, Tomita K et al (2006) How many ligations of bilateral segmental arteries cause ischemic spinal cord dysfunction? An experimental study using a dog model. Spine (Phila Pa 1976) 31:E781–E789. https://doi.org/10.1097/01.brs.0000238717.51102.79 CrossRef

21.

Ueda Y, Kawahara N, Tomita K et al (2005) Influence on spinal cord blood flow and function by interruption of bilateral segmental arteries at up to three levels: experimental study in dogs. Spine (Phila Pa 1976) 30:2239–2243. https://doi.org/10.1097/01.brs.0000182308.47248.59 CrossRef

22.

Rini BI, Campbell SC, Escudier B (2009) Renal cell carcinoma. Lancet 373:1119–1132. https://doi.org/10.1016/S0140-6736(09)60229-4 CrossRefPubMed

23.

Jackson R, Gokaslan Z, Arvinloh S (2001) Metastatic renal cell carcinoma of the spine: surgical treatment and results. J Neurosurg Spine 1:18CrossRef

24.

Prabhu VC, Bilsky MH, Jambhekar K et al (2003) Results of preoperative embolization for metastatic spinal neoplasms. J Neurosurg 98:156–164. https://doi.org/10.3171/spi.2003.98.2.0156 PubMedCrossRef

25.

Quraishi N, Purushothamdas S, Manoharan S (2013) Outcome of embolised vascular metastatic renal cell tumours causing spinal cord compression. Eur Spine 22:27–32CrossRef

Title: Preoperative embolization and local hemostatic agents in palliative decompression surgery for spinal metastases of renal cell carcinoma
Authors: Nikita Zaborovskii
Dmitrii Ptashnikov
Dmitrii Mikaylov
Sergei Masevnin
Oleg Smekalenkov
Publication date: 01-08-2018
Publisher: Springer Paris
Published in: European Journal of Orthopaedic Surgery & Traumatology / Issue 6/2018
Print ISSN: 1633-8065
Electronic ISSN: 1432-1068
DOI: https://doi.org/10.1007/s00590-018-2162-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Preoperative embolization and local hemostatic agents in palliative decompression surgery for spinal metastases of renal cell carcinoma

Abstract

Background

Materials and methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Materials and methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 6/2018

Effects on proprioception by Kinesio taping of the knee after anterior cruciate ligament rupture

Much ado about nothing: the effect of tourniquet time on an accelerated rehabilitation programme following total knee replacement (TKR)

Regenerative treatment of osteochondral lesions of distal tibial plafond

Nikkah, Dariush (eds): Hand trauma: illustrated surgical guide of core procedures

Correction to: The quadriceps active ratio: a dynamic MRI-based assessment of patellar height

Posterior resection of fifth lumbar giant schwannoma combined with a recapping transiliac approach: case report and technical note