Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
Department of Diagnostic Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.
Spine (Phila Pa 1976). 2024 Jun 15;49(12):E183-E190. doi: 10.1097/BRS.0000000000004780. Epub 2023 Jul 21.
A prospective consecutive case study.
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. Before surgery, the vascularity of the metastases was evaluated using CTP. On the basis of 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, visual analog scale score, neurological status, and the accuracy of vascularity evaluation by CTP confirmed by angiography. χ 2 testing was used to compare categorical variables, whereas independent sample t tests were used to compare continuous variables, with paired t tests used to assess differences from preoperative to postoperative time points.
The mean intraoperative blood loss was 485±167 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 visual analog scale scores 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.
前瞻性连续病例研究。
本研究旨在评估计算机断层灌注（CTP）评估胸腰椎转移瘤血管生成的准确性，并确定 CTP 与术前栓塞相结合对减少分离手术中术中失血量的影响。
胸腰椎转移瘤的手术是一项复杂的手术，有大量失血的风险。因此，在手术前评估肿瘤血管生成并采取措施减少术中失血量至关重要。
前瞻性纳入 62 例胸腰椎转移瘤患者。所有患者均采用后路分离手术。手术前，使用 CTP 评估转移瘤的血管生成。根据 CTP 结果，将患者分为富血管组和低血管组。对富血管组进行术前血管造影和栓塞。提取临床数据，包括术中出血量、围手术期并发症、视觉模拟评分、神经状态以及血管生成评估的 CTP 准确性，后者通过血管造影证实。χ2 检验用于比较分类变量，独立样本 t 检验用于比较连续变量，配对 t 检验用于评估术前至术后时间点的差异。
两组患者的平均术中出血量分别为 485±167 和 455±127.6ml。CTP 评估血管生成的准确性为 100%。在富血管组中，80.6%的患者神经状态至少有 1 个等级的改善，而低血管组中有 81.5%的患者有类似的改善。无患者出现神经恶化。两组患者术后视觉模拟评分均显著降低。
非侵入性 CTP 可准确评估胸腰椎转移瘤的血管生成。当与术前栓塞结合使用时，这种方法可有效且安全地减少分离手术中的术中失血量。
