Abstract
Purpose
To determine the frequency of major complications and identify related risk factors in surgery for hypervascular spinal tumors after preoperative selective arterial embolization.
Methods
Patients with spinal tumors who underwent preoperative embolizations between January 2010 and March 2013 were retrospectively reviewed. Perioperative complications were classified as either major or minor. Preoperative and intraoperative factors were analyzed for any association with major complications using univariate and multivariate regression analysis.
Results
There were 120 embolizations with subsequent 120 spine operations that met the inclusion and exclusion criteria. Overall, 27.5 % (33/120) experienced major complications and 11.7 % (14/120) had at least two major complications. Respiratory complications were the most commonly seen with a rate of 10.8 % (13/120). Multivariate regression analysis identified two risk factors for major complications: reoperation and higher score of surgical invasiveness index. Two risk factors were identified for two or more major complications: age ≥65 years and higher score of surgical invasiveness index. Two risk factors were identified for major respiratory complications: thoracic surgery and higher score of surgical invasiveness index. However, embolization-related factors did not reach significance in the multiple regression model.
Conclusion
Major complications in surgery for hypervascular spinal tumors after embolization are prevalent. Risk factors identified in this study are useful prognostic indicators when considering surgical treatment combined with embolization.
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References
Fisher CG, Saravanja DD, Dvorak MF et al (2011) Surgical management of primary bone tumors of the spine. Spine 36:830–836
Yamazaki T, McLoughlin GS, Patel S et al (2009) Feasibility and safety of en bloc resection for primary spine tumors. A systematic review by the Spine Oncology Study Group. Spine 34:S31–S38
Boriani S, Amendola L, Bandiera S et al (2012) Staging and treatment of osteoblastoma in the mobile spine: a review of 51 cases. Eur Spine J 21:2003–2010
Jansson KA, Bauer HC (2006) Survival, complications and outcome in 282 patients operated for neurological deficit due to thoracic or lumbar spinal metastases. Eur Spine J 15:196–202
Li H, Gasbarrini A, Cappuccio M et al (2009) Outcome of excisional surgeries for the patients with spinal metastases. Eur Spine J 18:1423–1430
Chong S, Shin SH, Yoo H et al (2012) Single-stage posterior decompression and stabilization for metastasis of the thoracic spine: prognostic factors for functional outcome and patients’ survival. Spine J 12:1083–1092
Lau D, Leach MR, Than KD et al (2013) Independent predictors of complication following surgery for spinal metastasis. Eur Spine J 22:1402–1407
Ozkan E, Gupta S (2011) Embolization of spinal tumors: vascular anatomy, indications, and technique. Tech Vasc Interv Radio 14:129–140
Guzman R, Dubach-Schwizer S, Heini P, Lovblad KO, Kalbermatten D, Schroth G, Remonda L (2005) Preoperative transarterial embolization of vertebral metastases. Eur Spine J 14:263–268
Nair S, Gobin YP, Leng LZ et al (2013) Preoperative embolization of hypervascular thoracic, lumbar, and sacral spinal column tumors: technique and outcomes from a single center. Interv Neuroradiol 19:377–385
Wilson MA, Cooke DL, Ghodke B et al (2010) Retrospective analysis of preoperative embolization of spinal tumors. AJNR 31:656–660
Thiex R, Harris MB, Sides C et al (2013) The role of preoperative transarterial embolization in spinal tumors. A large single-center experience. Spine J 13:141–149
Robial N, Charles YP, Bogorin I et al (2012) Is preoperative embolization a prerequisite for spinal metastases surgical management? Orthop Traumatol Surg Res 98:536–542
Zhang D, Yin H, Wu Z et al (2013) Surgery and survival outcomes of 22 patients with epidural spinal cord compression caused by thyroid tumor spinal metastases. Eur Spine J 22:569–576
Rehák S, Krajina A, Ungermann L et al (2008) The role of embolization in radical surgery of renal cell carcinoma spinal metastases. Acta Neurochir 150:1177–1181
Quraishi NA, Purushothamdas S, Manoharan SR et al (2013) Outcome of embolised vascular metastatic renal tumors causing spinal cord compression. Eur Spine J 22(Suppl 1):S27–S32
Mirza SK, Deyo RA, Heagerty PJ et al (2008) Development of an index to characterize the ‘‘invasiveness’’ of spine surgery: validation by comparison to blood loss and operative time. Spine 33:2651–2661
Auerbach JD, Lenke LG, Bridwell KH et al (2012) Major complications and comparison between 3-column osteotomy techniques in 105 consecutive spinal deformity procedures. Spine 37:1198–1210
Schwab FJ, Hawkinson N, Lafage V et al (2012) Risk factors for major peri-operative complications in adult spinal deformity surgery: a multi-center review of 953 consecutive patients. Eur Spine J 21:2603–2610
Pikis S, Itshayek E, Barzilay Y et al (2014) Preoperative embolization of hypervascular spinal tumors: current practice and center experience. Neurol Res 36(6):502–509
Prabhu VC, Bilsky MH, Jambhekar K, Panageas KS, Boland PJ, Lis E et al (2003) Results of preoperative embolization for metastatic spinal neoplasms. J Neurosurg 98:156–164
Kobayashi K, Ozkan E, Tam A et al (2012) Preoperative embolization of spinal tumors: variables affecting intraoperative blood loss after embolization. Acta Radiol 53:935–942
Jackson RJ, LohSC Gokaslan ZL et al (2001) Metastatic renal cell carcinoma of the spine: surgical treatment and results. J Neurosurg 94:18–24
Boriani S, Bandiera S, Donthineni R et al (2010) Morbidity of en bloc resections in the spine. Eur Spine J 19:231–241
Murakami H, Kawahara N, Tomita K et al (2010) Does interruption of the artery of Adamkiewicz during total en bolc spondylectomy affect neurologic function? Spine 35:1187–1192
Shehadi JA, Sciubba DM, Suk I et al (2007) Surgical treatment strategies and outcome in patients with breast cancer metastatic to the spine: a review of 87 patients. Eur Spine J 16:1179–1192
Lee MJ, Konodi MA, Cizik AM et al (2012) Risk factors for medical complication after spine surgery: a multivariate analysis of 1,591 patients. Spine J 12:197–206
Lee MJ, Hacquebord J, Varshney A et al (2011) Risk factors for medical complication after lumbar spine surgery. Spine 36:1801–1806
Mchenry TP, Mirza SK, Wang J et al (2006) Risk factors for respiratory failure following operative stabilization of thoracic and lumbar spine fractures. J Bone Joint Surg Am 88:997–1005
Cho SK, Bridwell KH, Lenke LG et al (2012) Major complications in revision adult deformity surgery. Spine 37:489–500
Acknowledgments
Special thanks go to Petros Boscainos (University of Dundee) for his assistance in editing this manuscript. Furthermore, we thank Xiaoping Kang (Peking University) and Han Wen (Peking University) for their assistance in statistical analysis.
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B. Tang and T. Ji contributed equally.
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Tang, B., Ji, T., Tang, X. et al. Risk factors for major complications in surgery for hypervascular spinal tumors: an analysis of 120 cases with adjuvant preoperative embolization. Eur Spine J 24, 2201–2208 (2015). https://doi.org/10.1007/s00586-015-4122-8
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DOI: https://doi.org/10.1007/s00586-015-4122-8