• Mark A Damante, David Gibbs, Khaled Dibs, Joshua D Palmer, Raju Raval, Thomas Scharschmidt, Arnab Chakravarti, Eric Bourekas, Daniel Boulter, Evan Thomas, John Grecula, Sasha Beyer, David Xu, Shahid Nimjee, Patrick Youssef, Russell Lonser, Dukagjin M Blakaj, and J Bradley Elder.
• Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
• Neurosurgery. 2023 Aug 1; 93 (2): 320329320-329.

BackgroundSpine metastases often cause significant pain, instability, and/or neurological morbidity. Local control (LC) of spine metastases has been augmented with advances in systemic therapies, radiation, and surgical technique. Prior reports suggest an association between preoperative arterial embolization and improved LC and palliative pain control.ObjectiveTo further elucidate the role of neoadjuvant embolization on LC of spine metastases and the potential for improved pain control in patients receiving surgery and stereotactic body radiotherapy (SBRT).MethodA retrospective single-center review between 2012 and 2020 identified 117 patients with spinal metastases from various solid tumor malignancies managed with surgery and adjuvant SBRT with or without preoperative spinal arterial embolization. Demographic information, radiographic studies, treatment characteristics, Karnofsky Performance Score, Defensive Veterans Pain Rating Scale, and mean daily doses of analgesic medications were reviewed. LC was assessed using magnetic resonance imaging obtained at a median 3-month interval and defined as progression at the surgically treated vertebral level.ResultsOf 117 patients, 47 (40.2%) underwent preoperative embolization, followed by surgery and SBRT and 70 (59.8%) underwent surgery and SBRT alone. Within the embolization cohort, the median LC was 14.2 months compared with 6.3 months among the nonembolization cohort ( P = .0434). Receiver operating characteristic analysis suggests ≥82.5% embolization predicted significantly improved LC (area under the curve = 0.808; P < .0001). Defensive Veterans Pain Rating Scale mean and maximum scores significantly decreased immediately after embolization ( P < .001).ConclusionPreoperative embolization was associated with improved LC and pain control suggesting a novel role for its use. Additional prospective study is warranted.Copyright © Congress of Neurological Surgeons 2023. All rights reserved.

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