Skip to main content

Advertisement

SpringerLink
Log in

Efficacy and safety of erythropoietin in isolated spinal metastasis patients with total en bloc spondylectomy surgery: a case–control study

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Objective

The purpose of our study is to identify the effect of short-term and high-dose use of erythropoietin (EPO) in spinal isolated metastatic patients with Total en bloc spondylectomy (TES) surgery by assessing hematological parameters, transfusion volume, postoperative complications, recurrence-free survival (RFS), and overall survival (OS).

Methods

From January 2015 and January 2022, 93 isolated spinal metastasis patients were selected and separated into 2 groups based on the treatment method used (EPO + TXA (Tranexamic acid) group, n = 47; and TXA group, n = 46). Indexes for evaluation included hemoglobin (Hb), hematocrit (Hct), red blood cells (RBC), RFS, OS, postoperative complications, postoperative Frankel Grade, drainage volume, transfusion rate, and mean units transfused.

Results

The average follow-up duration was 38.13 months. There was no significant difference (P > 0.05) in RFS, OS, postoperative complications, postoperative Frankel Grade, drainage volume, and transfusion rate between the two groups. However, patients in EPO + TXA group have significantly higher Hb, Hct, and RBC values than those in the TXA group on postoperative days 1, 2, 3, and 5. Moreover, the mean transfusion volume in EPO + TXA group was significantly lower than those in the TXA group (P = 0.011).

Conclusions

Perioperative short-term and high-dose administration of EPO could improve the anemia-related hematological parameters and reduce the requirement for blood transfusion without increasing the risk of deep vein thrombosis and tumor progression in solitary spinal metastatic patients with TES surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Roodman GD (2004) Mechanisms of bone metastasis. N Engl J Med 350:1655–1664. https://doi.org/10.1056/NEJMra030831

    Article  CAS  PubMed  Google Scholar 

  2. Spratt DE, Beeler WH, de Moraes FY, Rhines LD, Gemmete JJ, Chaudhary N, Shultz DB, Smith SR, Berlin A, Dahele M, Slotman BJ, Younge KC, Bilsky M, Park P, Szerlip NJ (2017) An integrated multidisciplinary algorithm for the management of spinal metastases: an International Spine Oncology Consortium report. Lancet Oncol 18:e720–e730. https://doi.org/10.1016/s1470-2045(17)30612-5

    Article  PubMed  Google Scholar 

  3. Gao X, Wu Z, Wang T, Cao J, Bai G, Xin B, Cao S, Jia Q, Liu T, Xiao J (2021) A discussion on the criteria for surgical decision-making in elderly patients with metastatic spinal cord compression. Global Spine J. https://doi.org/10.1177/2192568221991107

    Article  PubMed  PubMed Central  Google Scholar 

  4. Tomita K, Kawahara N, Kobayashi T, Yoshida A, Murakami H, Akamaru T (2001) Surgical strategy for spinal metastases. Spine 26:298–306. https://doi.org/10.1097/00007632-200102010-00016

    Article  CAS  PubMed  Google Scholar 

  5. Yao KC, Boriani S, Gokaslan ZL, Sundaresan N (2003) En bloc spondylectomy for spinal metastases: a review of techniques. Neurosurg Focus 15:E6. https://doi.org/10.3171/foc.2003.15.5.6

    Article  PubMed  Google Scholar 

  6. Rineau E, Stoyanov A, Samson E, Hubert L, Lasocki S (2017) Patient blood management in major orthopedic surgery: less erythropoietin and more iron? Anesth Analg 125:1597–1599. https://doi.org/10.1213/ANE.0000000000002086

    Article  PubMed  Google Scholar 

  7. Xu N, Zhang Y, Tian Y, Li B, Qiao H, Zhang X, Yang N, Li W, Zhang C, Li W, Fu W (2022) Prospective study of preoperative autologous blood donation for patients with high risk of allogeneic blood transfusion in lumbar fusion surgery: a study protocol of a randomised controlled trial. BMJ Open 12:e053846. https://doi.org/10.1136/bmjopen-2021-053846

    Article  PubMed  PubMed Central  Google Scholar 

  8. Steuber TD, Howard ML, Nisly SA (2016) Strategies for the management of postoperative anemia in elective orthopedic surgery. Ann Pharmacother 50:578–585. https://doi.org/10.1177/1060028016647977

    Article  CAS  PubMed  Google Scholar 

  9. Cao S, Gao X, Bai G, Xin B, Wang T, Cao J, Lv K, Zhu C, Ni X, Zou W, Zhou Y, Xiao J, Liu T (2021) Development and validation of a scoring system for differential diagnosis of tuberculosis and metastatic tumor in the spine. Infect Drug Resist 14:407–413. https://doi.org/10.2147/IDR.S298316

    Article  PubMed  PubMed Central  Google Scholar 

  10. Kelly MP, Zebala LP, Kim HJ, Sciubba DM, Smith JS, Shaffrey CI, Bess S, Klineberg E, Mundis G Jr, Burton D, Hart R, Soroceanu A, Schwab F, Lafage V, International Spine Study G (2016) Effectiveness of preoperative autologous blood donation for protection against allogeneic blood exposure in adult spinal deformity surgeries: a propensity-matched cohort analysis. J Neurosurg Spine 24:124–130. https://doi.org/10.3171/2015.4.SPINE141329

    Article  PubMed  Google Scholar 

  11. Lin DM, Lin ES, Tran MH (2013) Efficacy and safety of erythropoietin and intravenous iron in perioperative blood management: a systematic review. Transfus Med Rev 27:221–234. https://doi.org/10.1016/j.tmrv.2013.09.001

    Article  PubMed  Google Scholar 

  12. Garcia-Erce JA, Munoz M, Bisbe E, Saez M, Solano VM, Beltran S, Ruiz A, Cuenca J, Vicente-Thomas J (2004) Predeposit autologous donation in spinal surgery: a multicentre study. Eur Spine J 13(Suppl 1):S34-39. https://doi.org/10.1007/s00586-004-0726-0

    Article  PubMed  PubMed Central  Google Scholar 

  13. Kurian DJ, Guinn NR, Hunting J, Gamble JF, Hopkins TJ, Grimsley A, Guercio JR, Bolognesi MP, Schroeder R, Aronson S (2019) Preoperative blood management strategy for elective hip and knee arthroplasty. J Healthc Qual 41:376–383. https://doi.org/10.1097/JHQ.0000000000000207

    Article  PubMed  Google Scholar 

  14. Nakai S, Yoshizawa H, Kobayashi S, Naga K, Ichinose H (2000) Role of autologous blood transfusion in sacral tumor resection: patient selection and recovery after surgery and blood donation. J Orthop Sci Off J Jpn Orthop Assoc 5:321–327. https://doi.org/10.1007/s007760070037

    Article  CAS  Google Scholar 

  15. Guan XZ, Wang LL, Pan X, Liu L, Sun XL, Zhang XJ, Wang DQ, Yu Y (2020) Clinical indications of recombinant human erythropoietin in a single center: a 10-year retrospective study. Front Pharmacol 11:1110. https://doi.org/10.3389/fphar.2020.01110

    Article  PubMed  PubMed Central  Google Scholar 

  16. Duce L, Cooter ML, McCartney SL, Lombard FW, Guinn NR (2018) Outcomes in patients undergoing cardiac surgery who decline transfusion and received erythropoietin compared to patients who did not: a matched cohort study. Anesth Analg 127:490–495. https://doi.org/10.1213/ANE.0000000000002418

    Article  CAS  PubMed  Google Scholar 

  17. McKoy JM, Stonecash RE, Cournoyer D, Rossert J, Nissenson AR, Raisch DW, Casadevall N, Bennett CL (2008) Epoetin-associated pure red cell aplasia: past, present, and future considerations. Transfusion 48:1754–1762. https://doi.org/10.1111/j.1537-2995.2008.01749.x

    Article  PubMed  PubMed Central  Google Scholar 

  18. McGirr A, Pavenski K, Sharma B, Cusimano MD (2014) Blood conservation in neurosurgery: erythropoietin and autologous donation. Can J Neurol Sci 41:583–589. https://doi.org/10.1017/cjn.2014.14

    Article  PubMed  Google Scholar 

  19. Biboulet P, Motais C, Pencole M, Karam O, Dangelser G, Smilevitch P, Maissiat G, Capdevila X, Bringuier S (2020) Preoperative erythropoietin within a patient blood management program decreases both blood transfusion and postoperative anemia: a prospective observational study. Transfusion 60:1732–1740. https://doi.org/10.1111/trf.15900

    Article  CAS  PubMed  Google Scholar 

  20. Alghamdi AA, Albanna MJ, Guru V, Brister SJ (2006) Does the use of erythropoietin reduce the risk of exposure to allogeneic blood transfusion in cardiac surgery? A systematic review and meta-analysis. J Card Surg 21:320–326. https://doi.org/10.1111/j.1540-8191.2006.00241.x

    Article  PubMed  Google Scholar 

  21. Laupacis A, Fergusson D (1998) Erythropoietin to minimize perioperative blood transfusion: a systematic review of randomized trials. The International Study of Peri-operative Transfusion (ISPOT) Investigators. Transfus Med 8:309–317. https://doi.org/10.1046/j.1365-3148.1998.00171.x

    Article  CAS  PubMed  Google Scholar 

  22. Schiff SJ, Weinstein SL (1993) Use of recombinant human erythropoietin to avoid blood transfusion in a Jehovah’s Witness requiring hemispherectomy. Case report. J Neurosurg 79:600–602. https://doi.org/10.3171/jns.1993.79.4.0600

    Article  CAS  PubMed  Google Scholar 

  23. Kantrowitz AB, Spallone A, Taylor W, Chi TL, Strack M, Feghali JG (1994) Erythropoietin-augmented isovolemic hemodilution in skull-base surgery. Case report. J Neurosurg 80:740–744. https://doi.org/10.3171/jns.1994.80.4.0740

    Article  CAS  PubMed  Google Scholar 

  24. Boriani S, Weinstein JN, Biagini R (1997) Primary bone tumors of the spine. Terminology and surgical staging. Spine 22:1036–1044. https://doi.org/10.1097/00007632-199705010-00020

    Article  CAS  PubMed  Google Scholar 

  25. Ruan RX, Bai CW, Zhang L, Huang CR, Pan S, Zhang XC, Zhu ZY, Zheng X, Guo KJ (2020) Does subcutaneous administration of recombinant human erythropoietin increase thrombotic events in total hip arthroplasty? A prospective thrombelastography analysis. J Orthop Surg Res 15:546. https://doi.org/10.1186/s13018-020-02083-w

    Article  PubMed  PubMed Central  Google Scholar 

  26. Cao S, Gao X, Zhang Y, Wang Y, Wang J, Wang T, Liu Y, Hou S, Zhang J, Zhou Y, Liu T (2022) A comparison of two different surgical procedures in the treatment of isolated spinal metastasis patients with metastatic spinal cord compression: a case-control study. Eur Spine J 31:1583–1589. https://doi.org/10.1007/s00586-021-07032-7

    Article  PubMed  Google Scholar 

  27. Gao X, Li L, Cao J, Zhao Y, Liu Y, Yang J, Dong L, Wan W, Liu T, Xiao J (2019) Symptomatic postoperative spinal epidural hematoma after spine tumor surgery: Incidence, clinical features, and risk factors. Spinal Cord 57:708–713. https://doi.org/10.1038/s41393-019-0281-5

    Article  PubMed  Google Scholar 

  28. Kumar N, Zaw AS, Khine HE, Maharajan K, Wai KL, Tan B, Mastura S, Goy R (2016) Blood loss and transfusion requirements in metastatic spinal tumor surgery: evaluation of influencing factors. Ann Surg Oncol 23:2079–2086. https://doi.org/10.1245/s10434-016-5092-8

    Article  PubMed  Google Scholar 

  29. Cao S, Li L, Du Y, Gan J, Wang J, Wang T, Liu Y, Liu W, Zhou Y, Gao X, Li H, Liu T (2021) Porous gelatin microspheres for controlled drug delivery with high hemostatic efficacy. Colloids Surf B Biointerfaces 207:112013. https://doi.org/10.1016/j.colsurfb.2021.112013

    Article  CAS  PubMed  Google Scholar 

  30. Ikegami S, Takahashi J, Kuraishi S, Shimizu M, Futatsugi T, Uehara M, Horiuchi K, Shimodaira S, Kato H (2015) Efficacy of erythropoietin-beta injections during autologous blood donation before spinal deformity surgery in children and teenagers. Spine 40:E1144-1149. https://doi.org/10.1097/BRS.0000000000001108

    Article  PubMed  Google Scholar 

  31. Heschl M, Gombotz H, Haslinger-Eisterer B, Hofmann A, Bohler N, Meier J (2018) The efficacy of pre-operative preparation with intravenous iron and/or erythropoietin in anaemic patients undergoing orthopaedic surgery: an observational study. Eur J Anaesthesiol 35:289–297. https://doi.org/10.1097/EJA.0000000000000752

    Article  CAS  PubMed  Google Scholar 

  32. Wu YG, Zeng Y, Shen B, Si HB, Cao F, Yang TM, Pei FX (2016) Combination of erythropoietin and tranexamic acid in bilateral simultaneous total hip arthroplasty: a randomised, controlled trial. Hip Int 26:331–337. https://doi.org/10.5301/hipint.5000356

    Article  PubMed  Google Scholar 

  33. Bennett CL, Silver SM, Djulbegovic B, Samaras AT, Blau CA, Gleason KJ, Barnato SE, Elverman KM, Courtney DM, McKoy JM, Edwards BJ, Tigue CC, Raisch DW, Yarnold PR, Dorr DA, Kuzel TM, Tallman MS, Trifilio SM, West DP, Lai SY, Henke M (2008) Venous thromboembolism and mortality associated with recombinant erythropoietin and darbepoetin administration for the treatment of cancer-associated anemia. JAMA 299:914–924. https://doi.org/10.1001/jama.299.8.914

    Article  CAS  PubMed  Google Scholar 

  34. Zhao Y, Jiang C, Peng H, Feng B, Li Y, Weng X (2016) The effectiveness and safety of preoperative use of erythropoietin in patients scheduled for total hip or knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials. Medicine 95:e4122. https://doi.org/10.1097/md.0000000000004122

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Cho BC, Serini J, Zorrilla-Vaca A, Scott MJ, Gehrie EA, Frank SM, Grant MC (2019) Impact of preoperative erythropoietin on allogeneic blood transfusions in surgical patients: results from a systematic review and meta-analysis. Anesth Analg 128:981–992. https://doi.org/10.1213/ane.0000000000004005

    Article  CAS  PubMed  Google Scholar 

  36. Wise JJ, Fischgrund JS, Herkowitz HN, Montgomery D, Kurz LT (1999) Complication, survival rates, and risk factors of surgery for metastatic disease of the spine. Spine 24:1943–1951. https://doi.org/10.1097/00007632-199909150-00014

    Article  CAS  PubMed  Google Scholar 

  37. Abe E, Kobayashi T, Murai H, Suzuki T, Chiba M, Okuyama K (2001) Total spondylectomy for primary malignant, aggressive benign, and solitary metastatic bone tumors of the thoracolumbar spine. J Spinal Disord 14:237–246. https://doi.org/10.1097/00002517-200106000-00009

    Article  CAS  PubMed  Google Scholar 

  38. Sundaresan N, Rothman A, Manhart K, Kelliher K (2002) Surgery for solitary metastases of the spine: rationale and results of treatment. Spine 27:1802–1806. https://doi.org/10.1097/00007632-200208150-00021

    Article  PubMed  Google Scholar 

  39. Colomina MJ, Bago J, Pellise F, Godet C, Villanueva C (2004) Preoperative erythropoietin in spine surgery. Eur Spine J 13(Suppl 1):S40-49. https://doi.org/10.1007/s00586-004-0754-9

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

The funding was provided by National Natural Science Foundation of China, (Grant No. 81972506).

Author information

Author notes

  1. Shuang Cao, Kai Lv, Cheng Peng, and Guangjian Bai have contributed equally to this work, and all the four authors can be regarded as first authors.

Authors and Affiliations

  1. Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai, China

    Shuang Cao, Cheng Peng, Guangjian Bai, Xin Gao, Jing Wang, Jiashi Cao & Tielong Liu

  2. Department of Orthopedics, The Second People’s Hospital of Hefei, Hefei, Anhui Province, China

    Jianjun Chu

  3. Department of Orthopedics, Third Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China

    Rende Ning

  4. Department of Orthopedics, Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China

    Kai Lv

Authors
  1. Shuang Cao
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kai Lv
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Cheng Peng
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Guangjian Bai
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Xin Gao
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jing Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jiashi Cao
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Rende Ning
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jianjun Chu
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Tielong Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Rende Ning, Jianjun Chu or Tielong Liu.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cao, S., Lv, K., Peng, C. et al. Efficacy and safety of erythropoietin in isolated spinal metastasis patients with total en bloc spondylectomy surgery: a case–control study. Eur Spine J 32, 1021–1028 (2023). https://doi.org/10.1007/s00586-023-07554-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-023-07554-2

Keywords

Search

Navigation