Embolization of metastatic spinal tumors

Metastatic spinal lesions are frequently hypervascular, and surgery is associated with a risk of excessive intraoperative hemorrhage and resulting complications. Embolization procedures are safe and efficacious for treatment of metastatic spinal renal cell carcinoma, thyroid carcinoma, leiomyosarcoma, angiosarcoma, paraganlioma, pheochromocytoma, and hepatocellular carcinoma. Embolization of these tumors before surgery significantly reduces intraoperative blood loss, decreases the time in the operating room, improves tumor visualization, decreases tumor size, and facilitates complete resection, thereby eliminating the need for repeat surgeries. Embolization techniques are also used in the palliative treatment of pain and neurologic compromise in patients who are refractory to other treatment modalities, have recurrent or multiple tumors, or have significant comorbidities precluding surgical decompression. This study reviews the larger case series and significant case reports regarding the indications, techniques, and outcomes for embolization of spinal metastases.