scholarly journals Trends in Utilization of Preoperative Embolization for Spinal Metastases: A Study of the National Inpatient Sample 2005–2017

2021 ◽  
Vol 16 (1) ◽  
pp. 52-58
Author(s):  
Waseem Wahood ◽  
Alex Yohan Alexander ◽  
Yagiz Ugur Yolcu ◽  
Waleed Brinjikji ◽  
David F. Kallmes ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Renal Cancer ◽  
Lung Tumor ◽  
Spinal Metastasis ◽  
Spinal Metastases ◽  
Preoperative Embolization ◽  
National Inpatient Sample ◽  
Factors Associated ◽  
Hypervascular Tumors ◽  
Multivariable Regression

Purpose: While previous studies have suggested that preoperative embolization of hypervascular spinal metastases may alleviate intraoperative blood loss and improve resectability, trends and driving factors for choosing this approach have not been extensively explored. Therefore, we evaluated the trends and assessed the factors associated with preoperative embolization utilization for spinal metastatic tumors using a national inpatient database.Materials and Methods: The National Inpatient Sample database of the Healthcare Cost and Utilization Project was queried for patients undergoing surgical resection for spinal metastasis between January 1, 2005 and December 31, 2017. Patients undergoing preoperative embolization were identified; trends in the utilization of preoperative embolization were analyzed using the Cochran-Armitage test. Multivariable regression was conducted to assess factors associated with higher preoperative embolization utilization.Results: A total of 11,508 patients with spinal metastasis were identified; 105 (0.91%) underwent preoperative embolization. Of those 105 patients, 79 (75.24%) patients had a primary renal cancer, as compared to 1,732 (15.19%) of those who did not undergo preoperative embolization (P<0.001). The majority of patients in the non-preoperative embolization cohort had a primary lung tumor (n=3,562, 31.24%). Additionally, patient comorbidities were similar among the 2 groups (P>0.05). Trends in preoperative embolization indicated an increase of 0.16% (standard error: 0.024%, P<0.001) in utilization per year.Conclusion: Utilization of preoperative embolization for spinal metastasis is increasing yearly, especially for patients with renal cancer, suggesting that surgeons may increasingly consider embolization before surgical resection for hypervascular tumors. Additionally, the literature has shown the intraoperative and postoperative benefits of this procedure.

Preoperative Embolization of Hypervascular Spinal Metastases Using Percutaneous Direct Injection with n-Butyl Cyanoacrylate

Neurosurgery ◽  
2006 ◽  
Vol 59 (2) ◽  
pp. E431-E432 ◽  
Author(s):  
Clemens M. Schirmer ◽  
Adel M. Malek ◽  
Eddie S. Kwan ◽  
Daniel A. Hoit ◽  
Simcha J. Weller
Keyword(s):  
Blood Loss ◽  
Surgical Resection ◽  
Direct Injection ◽  
Transarterial Embolization ◽  
Spinal Instrumentation ◽  
Spinal Metastases ◽  
Preoperative Embolization ◽  
Iodized Oil ◽  
Operative Blood Loss ◽  
Perioperative Morbidity

Abstract OBJECTIVE: Intraoperative blood loss constitutes a major cause of perioperative morbidity in surgical decompression and reconstruction of highly vascular spinal metastatic tumors. We propose a technique for embolization of highly vascular vertebral metastases using percutaneous direct injection using n-butyl cyanoacrylate (NBCA) instead of polymethylmethacrylate to complement preoperative transarterial embolization and to minimize operative blood loss. METHODS: Five patients with renal cell carcinoma metastases to the spine (one cervical, one thoracic, and three lumbar) underwent embolization by percutaneous direct injection of the affected vertebrae with a mixture of NBCA and iodized oil to supplement transarterial embolization with polyvinyl alcohol particles and fibered platinum coils. This was achieved via a transpedicular approach in four cases and by direct vertebral body puncture in one case. RESULTS: The percutaneous NBCA direct injection procedure was technically successful in all cases and was not associated with neurological or medical complications. All patients underwent subsequent vertebrectomy and spinal instrumentation. Surgical resection was performed with lower than expected blood loss and with a subjective improvement in tumor tissue handling and dissection. CONCLUSION: The extent of tumor devascularization can be improved by supplementing transarterial embolization with NBCA direct injection to decrease operative blood loss and increase the safety of surgical resection and stabilization of highly vascular spinal metastases.

scholarly journals Only Tumors Angiographically Identified as Hypervascular Exhibit Lower Intraoperative Blood Loss Upon Selective Preoperative Embolization of Spinal Metastases: Systematic Review and Meta-Analysis

2021 ◽  
Vol 10 ◽  
Author(s):  
Yining Gong ◽  
Changming Wang ◽  
Hua Liu ◽  
Xiaoguang Liu ◽  
Liang Jiang
Keyword(s):  
Blood Loss ◽  
Retrospective Studies ◽  
Meta Analysis ◽  
Spinal Metastases ◽  
Preoperative Embolization ◽  
Intraoperative Blood Loss ◽  
Significant Difference ◽  
Hypervascular Tumors ◽  
Hypervascular Tumor ◽  
Tumor Types

BackgroundThe role of preoperative embolization (PE) in reducing intraoperative blood loss (IBL) during surgical treatment of spinal metastases remains controversial.MethodsA systematic search was conducted for retrospective studies and randomized controlled trials (RCTs) comparing the IBL between an embolization group (EG) and non-embolization group (NEG) for spinal metastases. IBL data of both groups were synthesized and analyzed for all tumor types, hypervascular tumor types, and non-hypervascular tumor types.ResultsIn total, 839 patients in 11 studies (one RCT and 10 retrospective studies) were included in the analysis. For all tumor types, the average IBL did not differ significantly between the EG and NEG in the RCT (P = 0.270), and there was no significant difference between the two groups in the retrospective studies (P = 0.05, standardized mean difference [SMD] = −0.51, 95% confidence interval [CI]: −1.03 to 0.00). For hypervascular tumors determined as such by consensus (n = 542), there was no significant difference between the two groups (P = 0.52, SMD = −0.25, 95% CI: −1.01 to 0.52). For those determined as such using angiographic evidence, the IBL was significantly lower in the EG than in the NEG group, in the RCT (P = 0.041) and in the retrospective studies (P = 0.004, SMD = −0.93, 95% CI: −1.55 to −.30). For IBL of non-hypervascular tumor types, both the retrospective study (P = 0.215) and RCT (P = 0.947) demonstrated no statistically significant differences in IBL between the groups.ConclusionsOnly tumors angiographically identified as hypervascular exhibited lower IBL upon PE in this study. Further exploration of non-invasive methods to identify the vascularity of tumors is warranted.

Intradural tumor recurrence after resection of extradural metastasis: a rare but potential complication of intraoperative durotomy

2014 ◽  
Vol 20 (6) ◽  
pp. 734-739 ◽  
Author(s):  
Manish K. Kasliwal ◽  
Lee A. Tan ◽  
John E. O'Toole
Keyword(s):  
Tumor Recurrence ◽  
Spinal Metastasis ◽  
Spinal Metastases ◽  
Intramedullary Tumor ◽  
Local Tumor ◽  
Local Tumor Recurrence ◽  
Tumor Dissemination ◽  
Intradural Tumor ◽  
Clinical Consequences ◽  
Clinical Awareness

Spinal metastases are the most common of spinal neoplasms and occur predominantly in an extradural location. Their appearance in an intradural location is uncommon and is associated with a poor prognosis. Cerebrospinal fluid dissemination accounts for a significant number of intradural spinal metastases mostly manifesting as leptomeningeal carcinomatoses or drop metastases from intracranial tumors. The occurrence of local tumor dissemination intradurally following surgery for an extradural spinal metastasis has not been reported previously. The authors describe 2 cases in which local intradural and intramedullary tumor recurrences occurred following resection of extradural metastases that were complicated by unintended durotomy. To heighten clinical awareness of this unusual form of local tumor recurrence, the authors discuss the possible etiology and clinical consequences of this entity.

scholarly journals Techniques of Onyx Embolization of Arteriovenous Malformation: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Kathryn M Wagner ◽  
Visish M Srinivasan ◽  
Peter Kan
Keyword(s):  
Informed Consent ◽  
Surgical Resection ◽  
Arteriovenous Malformations ◽  
Preoperative Embolization ◽  
Great Care ◽  
Endovascular Techniques ◽  
Definitive Therapy ◽  
Feeding Vessels ◽  
Multiple Feeding ◽  
Staged Treatment

Abstract Advances in endovascular techniques and tools have allowed for treatment of complex arteriovenous malformations (AVMs), which historically may have posed unacceptable risk for open surgical resection. Endovascular treatment may be employed as an adjunct to surgical resection or as definitive therapy. Improvements in embolization materials have made endovascular AVM treatment safer for patients and useful across a variety of lesions. While many techniques are employed for transarterial AVM embolization, the essential tenets apply to all procedures: (1) great care should be taken to cannulate only vessels directly supplying the lesion, and not en passage vessels, prior to injecting embolisate; (2) embolisate should travel into the nidus, but not into the draining veins; (3) embolistate reflux proximal to the microcatheter should be avoided. There are several techniques that accomplish these goals, including the plug and push method, or using a balloon to prevent embolisate reflux. We use controlled injection of liquid Onyx (Medtronic), with increasing pressure over multiple injections pushing the embolisate forward into the AVM. This is repeated in multiple feeding vessels to decrease or eliminate supply to the AVM. Here, we present a 36-yr-old female with a right parietal AVM discovered on workup of headaches. After informed consent was obtained, she underwent preoperative embolization using this technique prior to uncomplicated surgical resection. The video shows the endovascular Onyx embolization of multiple feeding vessels over staged treatment.

Factors Associated With Recurrent Back Pain and Cyst Recurrence After Surgical Resection of One Hundred Ninety-Five Spinal Synovial Cysts

Spine ◽  
2010 ◽  
Vol 35 (10) ◽  
pp. 1044-1053 ◽  
Author(s):  
Risheng Xu ◽  
Matthew J. McGirt ◽  
Scott L. Parker ◽  
Mohamed Bydon ◽  
Alessandro Olivi ◽  
...  
Keyword(s):  
Back Pain ◽  
Surgical Resection ◽  
Factors Associated ◽  
Synovial Cysts ◽  
Cyst Recurrence

Lessons Learnt in Health Management: Paediatric Spinal Tumours: A 6-year Retrospective Review from Central India

2021 ◽  
pp. 097206342110504
Author(s):  
Pranati Sharma ◽  
Shrikant V. Rege ◽  
Nilesh Jain
Keyword(s):  
Rare Disease ◽  
Surgical Resection ◽  
Medical Records ◽  
Spinal Metastasis ◽  
Public Awareness ◽  
Survival Rates ◽  
Central India ◽  
Neurological Status ◽  
Histopathological Diagnosis ◽  
Spinal Tumours

Background: From the management perspective, rare medical conditions do not attract enough attention, though their management can often be resource intensive. Increased awareness among health professionals can lead to early diagnosis of cases and prevention of complications leading to improved outcomes. Paediatric spinal tumours are rare disease entities with an annual incidence of approximately 1 per 1 million children. The profile of spinal tumours in the paediatric population is significantly different than that in adults. In this study we retrospectively analyse a heterogenous variety of paediatric spinal tumours which were treated at our institution over the last 6 years, with the goal of contributing to existing knowledge of this relatively rare disease entity. Methods: This retrospective study includes paediatric patients (under 18 years of age) who underwent surgery for primary spinal tumours from 2014 to 2019. The medical records were reviewed retrospectively and the information regarding clinical presentation, tumour location, operative findings, and postoperative status and functional outcome were analysed. The modified McCormick grade was used to assess the neurological status. Patients with spinal metastasis or incomplete medical records were excluded from the study. Results: Of 74 patients with primary spinal tumours operated at our centre between 2014 to 2019, a total of 8 patients (5 males and 3 females) who met the inclusion criteria were identified for the present study. The mean age of the patients included was 12.1±5.3 and the median follow-up period was 24 months. An improvement in the neurological status, as assessed by the modified McCormick grade, was seen in 37.5% of the patients. Three of the patients received adjuvant radiotherapy, post-surgical resection. A unique feature of this series was the wide variety of cases encountered, as each case had a different histopathological diagnosis, despite being limited by its sample size. Conclusion: Primary paediatric spinal cord tumours are rare, and surgical resection remains the treatment of choice. Adjuvant therapy is warranted in cases of high-grade lesions or recurrences. Through this study, we realised that due to its relative rarity and low incidence, a lack of public awareness can often lead to disproportionately increased morbidity and mortality. Prospective multi-centric studies can provide tools to help develop future management strategies for improved survival rates and reduced complications.

Recent advances and new discoveries in the pipeline of the treatment of primary spinal tumors and spinal metastases: A scoping review

2021 ◽  
Author(s):  
Julio C Furlan ◽  
Jefferson R Wilson ◽  
Eric M Massicotte ◽  
Arjun Sahgal ◽  
Fehlings G Michael
Keyword(s):  
Spinal Cord ◽  
Scoping Review ◽  
Clinical Studies ◽  
Spinal Metastasis ◽  
Spinal Cord Tumor ◽  
Treatment Strategies ◽  
Spinal Metastases ◽  
Spinal Tumors ◽  
Spinal Neoplasms ◽  
Primary Tumors

Abstract The field of spinal oncology has substantially evolved over the past decades. This review synthesizes and appraises what was learned and what will potentially be discovered from the recently completed and ongoing clinical studies related to the treatment of primary and secondary spinal neoplasms. This scoping review included all clinical studies on the treatment of spinal neoplasms registered in the ClinicalTrials.gov website from February/2000 to December/2020. The terms “spinal cord tumor”, “spinal metastasis”, and “metastatic spinal cord compression” were used. Of the 174 registered clinical studies on primary spinal tumors and spinal metastasis, most of the clinical studies registered in this American registry were interventional studies led by single institutions in North America (n=101), Europe (n=43), Asia (n=24) or other continents (n=6). The registered clinical studies mainly focused on treatment strategies for spinal neoplasms (90.2%) that included investigating stereotactic radiosurgery (n=33), radiotherapy (n=21), chemotherapy (n=20), and surgical technique (n=11). Of the 69 completed studies, the results from 44 studies were published in the literature. In conclusion, this review highlights the key features of the 174 clinical studies on spinal neoplasms that were registered from 2000 to 2020. Clinical trials were heavily skewed towards the metastatic population as opposed to the primary tumours which likely reflects the rarity of the latter condition and associated challenges in undertaking prospective clinical studies in this population. This review serves to emphasize the need for a focused approach to enhancing translational research in spinal neoplasms with a particular emphasis on primary tumors.

Trends, Sociodemographic and Hospital-Level Factors Associated With Palliative Care Utilization Among Multiple Myeloma Patients Using the National Inpatient Sample (2016-2018)

2021 ◽  
pp. 104990912110516
Author(s):  
Inimfon Jackson ◽  
Nsikak Jackson ◽  
Aniekeme Etuk
Keyword(s):  
Multiple Myeloma ◽  
Palliative Care ◽  
Private Insurance ◽  
Care Utilization ◽  
National Inpatient Sample ◽  
Hospital Level ◽  
Cross Sectional ◽  
Factors Associated ◽  
Patient Disposition ◽  
Prevalence Trends

Background: Several factors are reported to be associated with palliative care utilization among patients with various cancers, but literature is lacking on multiple myeloma (MM) specific factors. MM patients have a high symptom burden and early involvement of palliative could increase their quality of life. We examined factors associated with palliative care utilization among MM patients and explored prevalence trends in palliative care utilization among patients with MM. Methods: Cross-sectional analyses were conducted using the National Inpatient Sample data collected between 2016 and 2018. Descriptive analyses were used to explore prevalence trends in palliative care utilization over time. Multivariable logistic regression models were used to examine sociodemographic and hospital-level factors associated with palliative care utilization in MM patients. Results: Overall prevalence of palliative care utilization in our population was 7.7% with a trend of increasing use of palliative care from 7.3% in 2016 to 8.2% in 2018. MM patients aged 70 years and above had 1.30 times higher odds (95% CI: 1.20-1.42) of receiving palliative care relative to those younger than 70 years. Compared to non-Hispanic whites, non-Hispanic blacks (Adjusted odds ratio (AOR): 0.86; 95% CI: 0.79-0.94) were less likely to utilize palliative care. Patients on Medicaid (AOR: 1.27; 95% CI: 1.08-1.49), private insurance (AOR: 1.27; 95% CI: 1.16-1.39) and other insurance types (AOR: 2.10; 95% CI: 1.79-2.47) had significantly higher odds of receiving palliative care when compared to those on Medicare. Other factors identified were hospital region, location, patient disposition, admission type, length of stay, and number of comorbidities. Conclusion: Our findings highlight the urgent need for education of hospital physicians on the need for early palliative care involvement in the care of hospitalized MM patients. Messaging interventions such as the delivery of pop-up messages in electronic medical records to serve as reminders for physicians can be explored as a potential way to increase palliative care consultations for patients who need them.

scholarly journals Survival of Spinal Metastasis Disease based on Immunohistochemistry Subtype of Breast Cancer: A Systematic Review and Meta-analysis

2021 ◽  
Vol 9 (F) ◽  
pp. 101-105
Author(s):  
Ivan Hugo Hadisaputra ◽  
Tjokorda Gde Bagus Mahadewa ◽  
Putu Eka Mardhika
Keyword(s):  
Breast Cancer ◽  
Systematic Review ◽  
Survival Time ◽  
Spinal Metastasis ◽  
Meta Analysis ◽  
Spinal Metastases ◽  
Luminal A ◽  
Luminal B ◽  
Moderate Growth ◽  
Her 2

BACKGROUND: Breast cancer is categorized as a slow-growth tumor in the spinal metastases disease (SMD) scoring system. Based on immunohistochemistry, breast cancer has four subtypes: Luminal A (LumA), luminal B (LumB), human epidermal growth factor 2 (Her-2) type, and triple-negative breast cancer (TNBC). TNBC has the poorest prognosis. AIM: This study aimed to describe the survival time of breast cancer with SMD based on immunohistochemistry subtypes through systematic review and meta-analysis. METHODS: This is a systematic review and meta-analysis study. This study used electronic articles published in PubMed and CENTRAL online database. We used keywords ([breast] AND [cancer] AND [spine] AND [metastasis]) to find eligible studies. Articles included were full-text studies in English. Survival time as the outcome was pooled according to the immunohistochemistry subtype of breast cancer. Statistical analysis was performed using software Stata. RESULTS: Five articles met our inclusion and exclusion criteria. LumA, LumB, Her-2 type, and TNBC have a survival time of 32.84 months, 35.20 months, 60.8 months, and 14.27 months, respectively. CONCLUSION: TNBC has the lowest survival time in the pooled analysis. We proposed TNBC be categorized as a moderate growth primary tumor.

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