Preoperative embolization in surgical remedy of metastatic spinal wire compression.
Dan Med J. 2017 Jul;64(7):
Authors: Clausen C
An growing variety of sufferers develop symptomatic spinal metastasis and growing proof helps the advantage of surgical decompression and spinal stabilization mixed with radiation remedy. Nonetheless, surgical procedure for metastatic spinal illness is understood to be related to a danger of considerable intraoperative blood loss and perioperative allogenic blood transfusion. Anemia is understood to extend morbidity and mortality in sufferers present process surgical procedure, however research additionally point out that transfusion with allogenic crimson blood cells (RBC) might result in worse outcomes. To scale back intraoperative bleeding preoperative embolization has been utilized in chosen instances suspected for hypervascular spinal metastases, however no randomized trial has examined the impact. The ultimate choice on whether or not preoperative embolization ought to be carried out relies on the preoperative digital subtraction angiography (DSA) tumor blush, and as such thought-about the “gold commonplace” for figuring out the vascularity of spinal metastases. Reliability research evaluating vascularity rankings of DSA tumor blush haven’t been revealed earlier than. This PhD thesis relies on three research with the next goals: I. To evaluate whether or not perioperative allogenic blood transfusions in sufferers present process surgical remedy for spinal metastases independently affect affected person survival (Examine 1). II. To evaluate whether or not preoperative transcatheter arterial embolization of spinal metastases reduces blood loss, the necessity for transfusion with allogenic RBC and surgical procedure time within the surgical remedy of sufferers with symptomatic metastatic spinal wire compression (Examine 2). III. To explain the vascularity of metastasis inflicting spinal wire compression (Examine 2). IV. To judge inter- and intra-observer settlement within the evaluation of the vascularity of spinal metastases utilizing DSA tumor blush (Examine three). In conclusion the findings of this thesis display that preoperative embolization in sufferers with symptomatic spinal metastasis impartial of main tumor prognosis doesn’t cut back intraoperative blood loss and the necessity for allogenic RBC transfusion considerably, however does cut back the surgical procedure time. Nonetheless, a small discount of intraoperative blood loss was noticed within the hypervascular metastases. This tendency may very well be underestimated due to the examine design and moreover the tendency could also be enhanced in metastases of solely essentially the most pronounced hypervascularity. The findings moreover help that perioperative blood transfusion of lower than 5 models doesn’t lower survival in sufferers operated for spinal metastases and transfusion of 1-2 models appears to be weakly related to elevated 12-month survival. It was demonstrated that roughly 75 p.c of spinal metastases are hypervascular in a consecutive sequence of sufferers with signs of metastatic medullary compression and spinal instability operated by decompression and instrumented spinal stabilization. As well as the findings present that there’s passable average inter- and intrarater settlement in classifying the vascularity of spinal metastases on a three-step ordinal scale for DSA tumor blush. However, there’s a name for an correct preoperative approach to consider the vascularity of spinal metastases with a view to choose sufferers almost certainly to profit from preoperative embolization.
PMID: 28673383 [PubMed – indexed for MEDLINE]