Preoperative spinal tumor embolization: An institutional experience with Onyx

BackgroundPreoperative embolization has the potential to decrease intraoperative blood loss and facilitate spinal cord decompression and tumor resection.ObjectiveWe report our institutional experience with the embolization of hypervascular extradural spinal tumors with Onyx as well as earlier embolic agents in a series of 28 patients.MethodsA retrospective case review was conducted on patients undergoing preoperative transarterial embolization of a spinal tumor between 1995 and 2012 at our institution.ResultsTwenty-eight patients met the inclusion criteria, with a mean age of 60.6 years. Twenty-eight patients had metastatic tumors. In 14 (50%) patients the metastases were from renal cell carcinomas. Fifty-four vessels were embolized using PVA, NBCA, Onyx, coils, or embospheres. Sixteen patients were treated with Onyx, 6 patients with PVA, 3 patients with embospheres, 2 patients with NBCA, and 3 patients with a combination of embolic agents. The average decrease in tumor blush was 97.8% with Onyx versus 92.7% with the rest of the embolic agents (p = 0.08). The estimated blood loss was 1616 ml (range 350–5000 ml). Blood loss was 750 cm3 on average with Onyx versus 1844 with the rest of the embolic agents (p = 0.14). The mean length of stay was 16 days. The mortality rate was zero. Pre- and post-operative modified Rankin Score (mRS) did not differ significantly in the series (3.12 versus 3.10, respectively, p = 0.9).ConclusionIn our experience, the use of transarterial tumor embolization as an adjunct for spinal surgery is a safe and feasible option.