ABSTRACT
The spine is the most common site of bony metastatic disease, with the incidence of
spinal metastatic disease increasing, likely as a result of improved survivorship
in patients with cancer. Although occasionally incidentally identified through cancer
screening/staging or studies done for other reasons, spinal metastatic disease often
is symptomatic. The three key points to consider when devising a treatment algorithm
are neurological compromise, spinal instability, and individual patient factors. Because
the goal of treatment is almost always palliation, a multidisciplinary approach is
taken to offer the best chance at alleviating the patient's symptoms. Consideration
is given to various treatment choices, such as radiation therapy, chemotherapy, as
well as locoregional management strategies, such as thermal ablation (radiofrequency
and cryoablation). However, the mainstay of accepted management, especially in those
whose life expectancy is > 12 weeks where other strategies have failed, is surgical
resection and local stabilization. In this article we review the role and rationale
for preoperative embolization of spinal metastatic disease and discuss various related
issues, including determining who is most likely to benefit from preoperative embolization,
important anatomical considerations, and other technical points, such as timing of
surgery and accepted methods of achieving effective local tumor devascularization.
KEYWORDS
Embolization - spine - metastatic - preoperative
REFERENCES
manraj.heran@vch.ca
