190
· DOS Abstracts
Preoperative embolization in surgical treatment
of spinal metastases: single-blind, randomized
controlled clinical trial of efficacy in decreasing
intraoperative blood loss
Caroline Clausen, Benny Dahl, Susanne C Frevert, Lars Valentin,
Michael B Nielsen, Lars Lönn
Department of Radiology, Rigshospitalet and University of Copenhagen
; Department of Orthopaedic Surgery, Rigshospitalet and University of
Copenhagen
Background:
An increasing number of patients undergo surgical treatment for
symptomatic spinal metastasis. No randomized study has evaluated the effect
of preoperative embolization.
Purpose / Aim of Study:
To assess whether preoperative arterial embolization
reduce blood loss, blood transfusion, and duration of surgery in surgical treat-
ment of metastatic spinal cord compression.
Materials and Methods:
This single-blind, randomized (1:1), controlled, par-
allel-group, single-center trial was approved by the national committee on bio-
medical research ethics and preregistered. Informed consent was obtained and
the study period was from May 2011 until March 2013. All participants were
scheduled for decompression and posterior thoracic/lumbar spinal instrumen-
tation. They were randomly assigned to either 1) preoperative arteriography
and embolization – the embolization group or 2) preoperative arteriography
– the control group. Primary outcome: intraoperative blood loss. Secondary
outcomes: perioperative blood loss, allogenic RBC transfusion and duration of
surgery. Analyses were by intention-to-treat (ITT).
Findings / Results:
Forty-five randomized patients were available for the ITT.
Mean intraoperative blood loss did not differ significantly (P = .270) between
the embolization group (618 ml [SD, 282 ml]) and the control group (735 ml
[SD, 415 ml]). Neither did perioperative blood loss and allogenic RBC transfu-
sion. The duration of surgery, however, was significantly shorter in the embo-
lization group (P = .031): median 90 minutes (range, 54-252) vs. 124 minutes
(range, 80-183). Thirty-four of 45 metastases (76%) were hypervascular.
Conclusions:
Preoperative embolization does not result in a reduction of intra-
operative blood loss, perioperative blood loss and blood transfusion, but reduces
the duration of surgery for symptomatic metastatic spinal cord compression.
137.
