Is it necessary to embolise all spinal metastases from primary renal tumours?

Abstract

IntroductionSpinal metastases develop in 5-10% of all cancer patients, 1 and renal carcinoma metastases are associated with increased intraoperative blood loss relative to other tumour types. 2 Current studies suggest that as many as 83% of these metastases are hypervascular on angiographic studies. 3 Current best practice guidelines on the management of metastatic renal carcinoma suggest that, prior to any operative intervention on the metastatic deposits, they should undergo pre-operative embolisation to reduce the risk of catastrophic blood loss at the time of surgery. A lot of the published data on this topic are from the 1970s and 1980s 4-7 ;in 1974, Benati et al. concluded that multiple published case series' had successfully demonstrated the effectiveness of pre-operative embolisation. Success rates throughout the literature vary from 37 to 96%, 3,8 with complication rates varying from 1 to 32%. 3,8 Complications of pre-operative embolisation are not inconsequential; they range from transient paraesthesia and radicular pain to spinal cord ischaemia, epidural haemorrhage and permanent paraparesis. Despite this, current recommendations remain that all metastases from renal carcinoma should undergo embolisation prior to surgery. 9,10 It was the opinion of the senior author of this paper that this may not always be the case. The number of operationsj o u r n a l o f o r t h o p a e d i c s 1 3 ( 2 0 1 6 ) 4 7 2 -4 7 4

Assessing Vascularity of Osseous Spinal Metastases with Dual-Energy CT-DSA: A Pilot Study Compared with Catheter Angiography

“…3 However, aggressive spinal surgery could be complicated by massive intraoperative hemorrhage in hypervascular osseous metastases. Related studies have demonstrated that preoperative transarterial embolization might reduce intraoperative blood loss, [4][5][6][7][8][9] especially for pathologies prone to hypervascular metastases such as thyroid carcinoma, renal cell carcinoma, and hepatocellular carcinoma. However, not all metastases from such tumors are hypervascular, 5,10 and metastases from other tumor pathologies could be hypervascular as well.…”