The role of preoperative embolization in the treatment of spinal metastases from renal cell carcinoma

Background: One strategy to reduce extensive intraoperative bleeding for patients undergoing surgery for metastatic renal cell carcinoma (RCC) to the spine is preoperative embolization. Prior studies have shown mixed results. The objective of this study is to evaluate the efficacy of preoperative embolization in patients undergoing spine surgery for metastatic RCC with consideration of multiple confounders. We aim to assess blood loss and other outcomes reflective of functional status and postoperative complications.

Methods: A retrospective chart review was conducted for 43 patients that underwent surgery for metastatic spinal RCC and either received preoperative embolization (n = 29) or did not (n = 14). Mann Whitney tests were run for initial analyses. Multivariate regression models were then used to predict outcomes while controlling for multiple demographic and preoperative variables.

Results: Mann Whitney tests revealed a significant difference between the mean age of patients undergoing preoperative embolization in comparison to those that did not (59.2 years versus 52.4 years; p = 0.044). We found that preoperative embolization was not significantly associated with decreased blood loss (2257 mL versus 2000 mL; p = 0.97). There were also no significant differences between groups in post-procedural complications (34.5% versus 14.3%; p = 0.097), last follow-up Nurick score (β = 0.72, p = 0.18; 2.1 versus 1.6) or operative duration (β = 28, p = 0.66; 408 min versus 353 min). The female gender was found to be significantly associated with higher last follow-up Nurick scores (β = 1.24, p = 0.033).

Conclusion: We observed no differences in blood loss or other outcomes between patients undergoing preoperative embolization and those that did not.