Computed Tomography Perfusion Combined with Preoperative Embolization for Reducing Intraoperative Blood Loss in Separation Surgery for Thoracolumbar Metastases.
Journal
Spine
ISSN: 1528-1159
Titre abrégé: Spine (Phila Pa 1976)
Pays: United States
ID NLM: 7610646
Informations de publication
Date de publication:
21 Jul 2023
21 Jul 2023
Historique:
received:
09
03
2023
accepted:
02
07
2023
medline:
21
7
2023
pubmed:
21
7
2023
entrez:
21
7
2023
Statut:
aheadofprint
Résumé
A prospective consecutive case study. Objective: This study aimed to assess the accuracy of computed tomography perfusion (CTP) in evaluating the vascularity of thoracolumbar metastases and to determine the impact of combining CTP with preoperative embolization on reducing intraoperative blood loss during separation surgery. Surgery for thoracolumbar metastases is a complex procedure with the potential for substantial blood loss. Therefore, assessing tumor vascularity before surgery and taking measures to minimize intraoperative blood loss is essential. A total of 62 patients with thoracolumbar metastases were prospectively enrolled. All patients underwent separation surgery using the posterior approach. Prior to surgery, the vascularity of the metastases was evaluated using CTP. Based on the CTP results, patients were categorized into hypervascular and hypovascular groups. Preoperative angiography and embolization were performed for the hypervascular group. Clinical data were abstracted, including intraoperative blood loss, perioperative complications, VAS score, neurological status, and the accuracy of vascularity evaluation by CTP confirmed by angiography. Chi-square testing was used to compare categorical variables, while independent sample t-tests were employed to compare continuous variables, with paired t-tests were used to assess differences from preoperative to postoperative time points. The mean intraoperative blood loss was 485±167 mL and 455±127.6 mL in the two groups, respectively. The accuracy of vascularity evaluation by CTP was 100%. In the hypervascular group, 80.6% of the patients experienced at least one level of improvement in neurological status, while the hypovascular group had 81.5% of patients with similar improvement. None of the patients experienced neurological deterioration. There was a significant reduction in VAS score in both groups after the operation. The vascularity of thoracolumbar metastases could be accurately evaluated using noninvasive CTP. When combined with preoperative embolization, this approach effectively and safely reduced intraoperative blood loss in the setting of separation surgery.
Sections du résumé
STUDY DESIGN
METHODS
A prospective consecutive case study. Objective: This study aimed to assess the accuracy of computed tomography perfusion (CTP) in evaluating the vascularity of thoracolumbar metastases and to determine the impact of combining CTP with preoperative embolization on reducing intraoperative blood loss during separation surgery.
SUMMARY OF BACKGROUND DATA
BACKGROUND
Surgery for thoracolumbar metastases is a complex procedure with the potential for substantial blood loss. Therefore, assessing tumor vascularity before surgery and taking measures to minimize intraoperative blood loss is essential.
METHODS
METHODS
A total of 62 patients with thoracolumbar metastases were prospectively enrolled. All patients underwent separation surgery using the posterior approach. Prior to surgery, the vascularity of the metastases was evaluated using CTP. Based on the CTP results, patients were categorized into hypervascular and hypovascular groups. Preoperative angiography and embolization were performed for the hypervascular group. Clinical data were abstracted, including intraoperative blood loss, perioperative complications, VAS score, neurological status, and the accuracy of vascularity evaluation by CTP confirmed by angiography. Chi-square testing was used to compare categorical variables, while independent sample t-tests were employed to compare continuous variables, with paired t-tests were used to assess differences from preoperative to postoperative time points.
RESULTS
RESULTS
The mean intraoperative blood loss was 485±167 mL and 455±127.6 mL in the two groups, respectively. The accuracy of vascularity evaluation by CTP was 100%. In the hypervascular group, 80.6% of the patients experienced at least one level of improvement in neurological status, while the hypovascular group had 81.5% of patients with similar improvement. None of the patients experienced neurological deterioration. There was a significant reduction in VAS score in both groups after the operation.
CONCLUSION
CONCLUSIONS
The vascularity of thoracolumbar metastases could be accurately evaluated using noninvasive CTP. When combined with preoperative embolization, this approach effectively and safely reduced intraoperative blood loss in the setting of separation surgery.
Identifiants
pubmed: 37477335
doi: 10.1097/BRS.0000000000004780
pii: 00007632-990000000-00420
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
Conflict of interest: No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript. The manuscript submitted does not contain information about medical device(s)/drug(s).