Caroline Clausen MD, Presenter: Nothing to Disclose

Benny Dahl MD, PhD, Abstract Co-Author: Nothing to Disclose

Susanne Christiansen Frevert MD, Abstract Co-Author: Nothing to Disclose

Lars Valentin MD, Abstract Co-Author: Nothing to Disclose

Michael Bachmann Nielsen MD, PhD, Abstract Co-Author: Nothing to Disclose

Lars Lonn MD, PhD, Abstract Co-Author: Nothing to Disclose

To assess whether preoperative embolization reduces intraoperative blood loss, the need for blood transfusion, and operative time in the surgical treatment of symptomatic metastatic spinal cord compression.

A single-blind, randomized (balanced 1:1), controlled, parallel-group trial conducted as a single-center study; 48 participants were included from May 2011 until March 2013. Participants scheduled for decompression and posterior thoracic/lumbar instrumented spinal instrumentation because of symptomatic metastatic spinal cord compression were randomly assigned to either preoperative arteriography and embolization – the intervention group or preoperative arteriography – the control group. Primary outcome: intraoperative blood loss. Secondary outcomes: Intra- plus postoperative blood loss, blood transfusion and duration of surgery. Outcomes were reported as intention-to-treat analyses (ITT) including all randomized patients with a standing consent to participate and meeting the inclusion criteria.

Of the 48 randomized patients, 45 (23:22) were available for the ITT after exclusion of patients violating inclusion criteria. Mean intraoperative blood loss did not differ significantly between the embolization group (618 ml; SD 282 ml) and the control group (735 ml; SD 415 ml). This was also the case for intra- plus postoperative blood loss and the need for blood transfusion. The duration of surgery was shorter in the embolization group compared to the control group (p=0.031); median 90 minutes (range 54-252) vs. 124 minutes (range 80-183).  

Preoperative embolization does not result in a reduction of intraoperative blood loss and blood transfusion, but reduces the duration of surgery. The general routine use of preoperative embolization cannot be recommended in decompression and posterior instrumented spinal instrumentation for symptomatic metastatic spinal cord compression.

This randomized controlled clinical trial displays that preoperative embolization has the advantage of reducing the duration of surgery for symptomatic metastatic spinal cord compression.

Clausen, C, Dahl, B, Frevert, S, Valentin, L, Nielsen, M, Lonn, L, Preoperative Embolization in Surgical Treatment of Spinal Metastases: Single-Blind, Randomized Controlled Clinical Trial of Efficacy in Decreasing Intraoperative Blood Loss.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14007893.html