Pre-operative Spine Tumor Embolization: Clinical Outcomes and Effect of Embolization Completeness

Background and Purpose: To assess the association between the impact of the completeness of pre-operative spine tumour embolization and clinical outcomes including estimated blood loss (EBL), neurological status, and complications. Materials and Methods: Retrospective chart review of all preoperative spine tumour embolization procedures performed over 11 years by a single operator (2007-2018) at Vancouver General Hospital, on 40 consecutive patients (mean age 58; 77.5% males) with 42 embolization procedures, of which surgery was done en bloc in 22 cases and intralesional in the remaining 20. A multivariable negative binomial regression model was fit to examine the association between EBL and surgery type, tumour characteristics, embolization completeness and operative duration. Results: Among intralesional surgeries, complete versus incomplete embolization was associated with reduced blood loss (772 vs 1428 mL, P < 0.001). There was no statistically significant difference in neurological outcomes or complications between groups. Highly vascular tumours correlated with greater blood loss than their less vascular counterparts, but tumour location did not have a statistically significant effect. Conclusion: This study provides early evidence in support of our hypothesis that complete as opposed to incomplete tumour embolization correlates with reduced blood loss in intralesional surgeries. Randomized control trials with larger samples are necessary to confirm this benefit and to ascertain other potential clinical benefits. ### Competing Interest Statement Charles Fisher: Royalties: Medtronic Consulting: Medtronic, Nuvasive Fellowship Support paid to institution: Medtronic, AO Spine The remaining authors declare no conflicts of interest or relevant financial interests. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The UBC clinical research ethics board (reference # H16-02462) of the the University of British Columbia gave ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors