Preoperative Embolization in the Treatment of Spinal Metastasis

Truumees, Eeric; Dodwad, Shah-Nawaz M.; Kazmierczak, Chris D.

doi:10.5435/00124635-201008000-00001

Cited by 32 publications

(24 citation statements)

References 18 publications

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“…1 The incidence of metastases to the spinal axis continues to increase, thought to be due to increasing survival times in patients with cancer as a result of improvements in local and systemic cancer therapy. [1][2][3][4][5][6] Synchronous or metachronous spinal metastases can be seen in 5% of cancer patients, with more than a third of patients having evidence of spinal metastatic disease (SMD) at autopsy. The most common site of SMD is the thoracic spine (70%), followed by the lumbosacral region (22%), and then the cervical spine (8%).…”

Section: Introductionmentioning

confidence: 99%

Preoperative Embolization of Spinal Metastatic Disease: Rationale and Technical Considerations

Heran

2011

Semin Musculoskelet Radiol

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The spine is the most common site of bony metastatic disease, with the incidence of spinal metastatic disease increasing, likely as a result of improved survivorship in patients with cancer. Although occasionally incidentally identified through cancer screening/staging or studies done for other reasons, spinal metastatic disease often is symptomatic. The three key points to consider when devising a treatment algorithm are neurological compromise, spinal instability, and individual patient factors. Because the goal of treatment is almost always palliation, a multidisciplinary approach is taken to offer the best chance at alleviating the patient's symptoms. Consideration is given to various treatment choices, such as radiation therapy, chemotherapy, as well as locoregional management strategies, such as thermal ablation (radiofrequency and cryoablation). However, the mainstay of accepted management, especially in those whose life expectancy is > 12 weeks where other strategies have failed, is surgical resection and local stabilization. In this article we review the role and rationale for preoperative embolization of spinal metastatic disease and discuss various related issues, including determining who is most likely to benefit from preoperative embolization, important anatomical considerations, and other technical points, such as timing of surgery and accepted methods of achieving effective local tumor devascularization.

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Section: Introductionmentioning

confidence: 99%

Preoperative Embolization of Spinal Metastatic Disease: Rationale and Technical Considerations

Heran

2011

Semin Musculoskelet Radiol

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“…13 However, the embolization of spine lesions may represent a challenge when the feeders to the metastatic lesion also supply the ASA. In this configuration, regular embolization using PVA microparticles via arterial access may be associated with a high risk of neurological complication.…”

Section: Discussionmentioning

confidence: 99%

Onyx injection by direct puncture for the treatment of hypervascular spinal metastases close to the anterior spinal artery: initial experience

Clarençon

Maria

Cormier

et al. 2013

SPI

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Presurgical devascularization of hypervascular spinal metastases has been shown to be effective in preventing major blood loss during open surgery. Most often, embolization can be performed using polyvinyl alcohol (PVA) microparticles. However, in some cases, the close relationship between the feeders of the metastases and the feeders of the anterior spinal artery (ASA) poses a risk of spinal cord ischemia when PVA microparticle embolization is performed. The authors present their early experience in the treatment of spinal metastases close to the ASA; in 2 cases they injected Onyx-18, by direct puncture, into hypervascular posterior arch spinal metastases situated close to the ASA. Two women, one 36 and the other 55 years of age, who presented with spinal lesions (at the posterior arch of C-4 and T-6, respectively) from thyroid and a kidney tumors, were sent to the authors' department to undergo presurgical embolization. After having performed a complete spinal digital subtraction angiography study, a regular angiography catheter was positioned at the ostium of the artery that mainly supplied the lesion. Then, with the patient in the left lateral decubitus position, direct puncture with 18-gauge needles of the lesion was performed using roadmap guidance. Onyx-18 was injected through the needles under biplanar fluoroscopy. Satisfactory devascularization of the lesions was obtained; the ASA remained patent in both cases. The metastases were surgically removed in both cases within the 48 hours after the embolization and major blood loss did not occur. Presurgical devascularization of hypervascular spinal metastases close the ASA by direct puncture with Onyx-18 seems to be an effective technique and appears to be safe in terms of the preserving the ASA's patency.

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“…Thus, vas embolism operation is an effective treatment method that is palliative for symptomatic bone metastases. Truumees et al (37) believed that >60% of spinal metastases were hypervascular and preoperative embolization was considered to decrease the hemorrhage risk and improve outcomes. Vas embolism operation can suppress tumor growth, but is not able to restore the biomechanics of the affected vertebrae.…”

Section: Vascular Thrombosis Combined With Pvp Surgerymentioning

confidence: 99%

Advances in the clinical research of the minimally invasive treatment for the posterior edge of vertebral-body defects by spinal metastases

et al. 2015

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Abstract.Spinal metastasis is one of the commonly observed complications in the advanced stages of cancer patients, and is a serious threat to human life and health. Malignant tumor invasion usually leads to defects in the posterior margins of the vertebral body, which caused significant cancer pains to patients and increased the risk of surgery. Currently, minimally invasive treatments of vertebral defects caused by spinal metastases include percutaneous vertebroplasty (PVP) combined with radiofrequency ablation and PVP combined with 125 I seed implantation. These minimally invasive techniques have particular superiority to control pain in patients with spinal metastases, improve nerve function, reduce the incidence of fractures and surgical risk, and improve the quality of life. The present study reviewed the progress in clinical research on vertebral defects caused by spinal metastases, and the mechanisms and minimally invasive treatment.

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Preoperative Embolization in the Treatment of Spinal Metastasis

Cited by 32 publications

References 18 publications

Preoperative Embolization of Spinal Metastatic Disease: Rationale and Technical Considerations

Preoperative Embolization of Spinal Metastatic Disease: Rationale and Technical Considerations

Onyx injection by direct puncture for the treatment of hypervascular spinal metastases close to the anterior spinal artery: initial experience

Advances in the clinical research of the minimally invasive treatment for the posterior edge of vertebral-body defects by spinal metastases

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