{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T03:12:25Z","timestamp":1774321945622,"version":"3.50.1"},"reference-count":62,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,17]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>While preoperative embolization (PrE) is known to reduce blood loss during spinal surgery for histopathologically hypervascular metastases, its efficacy in nonhypervascular spinal metastases remains underexplored. This study aimed to evaluate the effectiveness of PrE in patients with nonhypervascular spinal metastatic tumors, focusing primarily on estimated blood loss (EBL) and secondarily on perioperative outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>This retrospective study included 152 patients diagnosed with nonhypervascular thoracolumbar spinal metastases who underwent surgery between January 2018 and December 2022. Propensity score matching was performed to balance surgical indications and clinicodemographic characteristics, resulting in 55 matched pairs (110 patients) with or without PrE. Surgical outcomes (overall EBL, perioperative blood transfusion, operation time, reoperation rate, massive EBL [defined as \u2265 2500 mL], and 30- and 90-day mortality) were compared. Prespecified subgroup analyses were also conducted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      The matched PrE group had significantly lower overall EBL (median 600 [IQR 300\u20131200] mL) compared with the matched non-PrE group (median 900 [IQR 500\u20131800] mL) (p = 0.02). The incidence of massive EBL was also lower in the PrE group (3 patients [5.5%]) than in the non-PrE group (10 patients [18.2%], p = 0.03; OR 0.26 [95% CI 0.06\u20130.91]). No significant differences were observed between groups regarding perioperative transfusion, operation time, reoperation rate, 30-day mortality, or 90-day mortality. However, 1 case of PrE-related spinal cord infarction occurred. Subgroup analyses revealed that PrE was more effective in reducing massive EBL among patients with hyperenhancement on preoperative CT\u2013digital subtraction angiography and those undergoing highly invasive surgery (p\n                      <jats:sub>interaction<\/jats:sub>\n                      = 0.02 and 0.03, respectively).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>After adjusting for clinicodemographic factors, PrE was associated with reduced EBL in patients with nonhypervascular thoracolumbar spinal metastases. Moreover, patients with radiological hyperenhancement or undergoing highly invasive surgery may derive greater benefit from PrE in mitigating massive EBL.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.6.spine25223","type":"journal-article","created":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T20:52:18Z","timestamp":1763412738000},"page":"165-174","source":"Crossref","is-referenced-by-count":1,"title":["Effects of preoperative embolization on outcomes in histopathologically nonhypervascular spinal metastases: a propensity score\u2013matched study"],"prefix":"10.3171","volume":"44","author":[{"given":"Ting-Wei","family":"Liao","sequence":"first","affiliation":[{"name":"Department of Medical Imaging, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu;"},{"name":"Department of Medical Imaging, National Taiwan University Hospital, Taipei;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu-Cheng","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging, National Taiwan University Hospital, Taipei;"},{"name":"Spine Tumor Center, National Taiwan University Hospital, Taipei; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yen-Heng","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging, National Taiwan University Hospital, Taipei;"},{"name":"Spine Tumor Center, National Taiwan University Hospital, Taipei; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fon-Yih","family":"Tsuang","sequence":"additional","affiliation":[{"name":"Spine Tumor Center, National Taiwan University Hospital, Taipei; and"},{"name":"Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"1103","key":"b1","series-title":"Br J Radiol","first-page":"20190211","article-title":"Spinal metastasis: diagnosis, management and follow-up","volume":"92","author":"Mossa-Basha M","year":"2019","unstructured":"Mossa-Basha M, Gerszten PC, Myrehaug S,  Spinal metastasis: diagnosis, management and follow-up. Br J Radiol. 2019;92(1103):20190211."},{"issue":"10","key":"b2","series-title":"Oncologist","first-page":"1205","article-title":"The metastatic spine disease multidisciplinary working group algorithms","volume":"20","author":"Wallace AN","year":"2015","unstructured":"Wallace AN, Robinson CG, Meyer J,  The metastatic spine disease multidisciplinary working group algorithms. Oncologist. 2015;20(10):1205\u20131215."},{"issue":"3","key":"b3","series-title":"Tech Vasc Interv Radiol","first-page":"129","article-title":"Embolization of spinal tumors: vascular anatomy, indications, and technique","volume":"14","author":"Ozkan E","year":"2011","unstructured":"Ozkan E, Gupta S. Embolization of spinal tumors: vascular anatomy, indications, and technique. 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J Orthop Sci. 2005;10(3):253\u2013257."},{"issue":"7","key":"b12","series-title":"Spine (Phila Pa 1976)","first-page":"437","article-title":"Surgical outcomes after preoperative embolization in hypervascular spinal metastases: a propensity scored study of 191 patients","volume":"50","author":"Pierik RJB","year":"2025","unstructured":"Pierik RJB, Amelink JJGJ, Groot OQ,  Surgical outcomes after preoperative embolization in hypervascular spinal metastases: a propensity scored study of 191 patients. 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J Korean Neurosurg Soc. 2019;62(1):106\u2013113."},{"issue":"6","key":"b25","series-title":"Acta Radiol","first-page":"734","article-title":"Inter-and intra-rater agreement in the assessment of the vascularity of spinal metastases using digital subtraction angiography tumor blush","volume":"58","author":"Clausen C","year":"2017","unstructured":"Clausen C, Dahl B, Christiansen Frevert S, Forman JL, Nielsen MB, L\u00f6nn L. Inter-and intra-rater agreement in the assessment of the vascularity of spinal metastases using digital subtraction angiography tumor blush. Acta Radiol. 2017;58(6):734\u2013739."},{"issue":"2","key":"b26","series-title":"Neurosurg Focus","first-page":"E16","article-title":"Imaging diagnosis and the role of endovascular embolization treatment for vascular intraspinal tumors","volume":"39","author":"dos Santos MP","year":"2015","unstructured":"dos Santos MP, Zhang J, Ghinda D,  Imaging diagnosis and the role of endovascular embolization treatment for vascular intraspinal tumors. Neurosurg Focus. 2015;39(2):E16."},{"key":"b27","series-title":"Int J Surg Oncol","first-page":"769753","article-title":"Imaging of spinal metastatic disease","volume":"2011","author":"Shah LM","year":"2011","unstructured":"Shah LM, Salzman KL. Imaging of spinal metastatic disease. Int J Surg Oncol. 2011;2011:769753."},{"issue":"12","key":"b28","series-title":"Eur Spine J","first-page":"3952","article-title":"Dynamic contrast-enhanced MRI for the assessment of spinal tumor vascularity: correlation with angiography","volume":"25","author":"Meng XX","year":"2016","unstructured":"Meng XX, Zhang YQ, Liao HQ,  Dynamic contrast-enhanced MRI for the assessment of spinal tumor vascularity: correlation with angiography. Eur Spine J. 2016;25(12):3952\u20133961."},{"issue":"7","key":"b29","series-title":"Eur Radiol","first-page":"4690","article-title":"Reliability and accuracy of time-resolved contrast-enhanced magnetic resonance angiography in hypervascular spinal metastases prior embolization","volume":"31","author":"Premat K","year":"2021","unstructured":"Premat K, Shotar E, Burns R,  Reliability and accuracy of time-resolved contrast-enhanced magnetic resonance angiography in hypervascular spinal metastases prior embolization. Eur Radiol. 2021;31(7):4690\u20134699."},{"issue":"24","key":"b30","series-title":"Spine (Phila Pa 1976)","first-page":"2651","article-title":"Development of an index to characterize the \"invasiveness\" of spine surgery: validation by comparison to blood loss and operative time","volume":"33","author":"Mirza SK","year":"2008","unstructured":"Mirza SK, Deyo RA, Heagerty PJ,  Development of an index to characterize the \"invasiveness\" of spine surgery: validation by comparison to blood loss and operative time. 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Br J Radiol. 2019;92(1103):20190211."},{"issue":"10","key":"b2","series-title":"Oncologist","first-page":"1205","article-title":"The metastatic spine disease multidisciplinary working group algorithms","volume":"20","author":"Wallace AN","year":"2015","unstructured":"Wallace AN, Robinson CG, Meyer J,  The metastatic spine disease multidisciplinary working group algorithms. Oncologist. 2015;20(10):1205\u20131215."},{"issue":"3","key":"b3","series-title":"Tech Vasc Interv Radiol","first-page":"129","article-title":"Embolization of spinal tumors: vascular anatomy, indications, and technique","volume":"14","author":"Ozkan E","year":"2011","unstructured":"Ozkan E, Gupta S. Embolization of spinal tumors: vascular anatomy, indications, and technique. Tech Vasc Interv Radiol. 2011;14(3):129\u2013140."},{"issue":"2","key":"b4","series-title":"Br J Surg","first-page":"e26","article-title":"Strategies to minimize intraoperative blood loss during major surgery","volume":"107","author":"Shah A","year":"2020","unstructured":"Shah A, Palmer A, Klein A. Strategies to minimize intraoperative blood loss during major surgery. Br J Surg. 2020;107(2):e26\u2013e38."},{"issue":"5","key":"b5","series-title":"Neurosurgery","first-page":"755","article-title":"Preoperative superselective arteriolar embolization: a new approach to enhance resectability of spinal tumors","volume":"27","author":"Broaddus W","year":"1990","unstructured":"Broaddus W, Grady M, Delashaw J Jr, Ferguson R, Jane J. Preoperative superselective arteriolar embolization: a new approach to enhance resectability of spinal tumors. Neurosurgery. 1990;27(5):755\u2013759."},{"key":"b6","series-title":"World Neurosurg","first-page":"e745","article-title":"Effectiveness of preoperative embolization in patients with spinal metastases: a systematic review and meta-analysis","volume":"152","author":"Gao ZY","year":"2021","unstructured":"Gao ZY, Zhang T, Zhang H, Pang CG, Xia Q. Effectiveness of preoperative embolization in patients with spinal metastases: a systematic review and meta-analysis. World Neurosurg. 2021;152:e745\u2013e757."},{"key":"b7","series-title":"World Neurosurg","first-page":"362","article-title":"Preoperative embolization of spinal tumors: a systematic review and meta-analysis","volume":"87","author":"Griessenauer CJ","year":"2016","unstructured":"Griessenauer CJ, Salem M, Hendrix P, Foreman PM, Ogilvy CS, Thomas AJ. Preoperative embolization of spinal tumors: a systematic review and meta-analysis. World Neurosurg. 2016;87:362\u2013371."},{"issue":"3","key":"b8","series-title":"Eur Spine J","first-page":"263","article-title":"Preoperative transarterial embolization of vertebral metastases","volume":"14","author":"Guzman R","year":"2005","unstructured":"Guzman R, Dubach-Schwizer S, Heini P,  Preoperative transarterial embolization of vertebral metastases. Eur Spine J. 2005;14(3):263\u2013268."},{"issue":"6","key":"b9","series-title":"J Neurointerv Surg","first-page":"596","article-title":"Systematic review and meta-analysis of effectiveness of preoperative embolization in surgery for metastatic spine disease","volume":"10","author":"Luksanapruksa P","year":"2018","unstructured":"Luksanapruksa P, Buchowski JM, Tongsai S, Singhatanadgige W, Jennings JW. Systematic review and meta-analysis of effectiveness of preoperative embolization in surgery for metastatic spine disease. J Neurointerv Surg. 2018;10(6):596\u2013601."},{"issue":"4","key":"b10","series-title":"AJNR Am J Neuroradiol","first-page":"656","article-title":"Retrospective analysis of preoperative embolization of spinal tumors","volume":"31","author":"Wilson M","year":"2010","unstructured":"Wilson M, Cooke D, Ghodke B, Mirza S. Retrospective analysis of preoperative embolization of spinal tumors. AJNR Am J Neuroradiol. 2010;31(4):656\u2013660."},{"issue":"3","key":"b11","series-title":"J Orthop Sci","first-page":"253","article-title":"Preoperative embolization in spinal and pelvic metastases","volume":"10","author":"Wirbel RJ","year":"2005","unstructured":"Wirbel RJ, Roth R, Schulte M, Kramann B, Mutschler W. Preoperative embolization in spinal and pelvic metastases. J Orthop Sci. 2005;10(3):253\u2013257."},{"issue":"7","key":"b12","series-title":"Spine (Phila Pa 1976)","first-page":"437","article-title":"Surgical outcomes after preoperative embolization in hypervascular spinal metastases: a propensity scored study of 191 patients","volume":"50","author":"Pierik RJB","year":"2025","unstructured":"Pierik RJB, Amelink JJGJ, Groot OQ,  Surgical outcomes after preoperative embolization in hypervascular spinal metastases: a propensity scored study of 191 patients. Spine (Phila Pa 1976). 2025;50(7):437\u2013446."},{"issue":"22","key":"b13","series-title":"Spine (Phila Pa 1976)","first-page":"E1221","article-title":"A novel classification system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the Spine Oncology Study Group","volume":"35","author":"Fisher CG","year":"2010","unstructured":"Fisher CG, DiPaola CP, Ryken TC,  A novel classification system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the Spine Oncology Study Group. Spine (Phila Pa 1976). 2010;35(22):E1221\u2013E1229."},{"issue":"3","key":"b14","series-title":"Paraplegia","first-page":"179","article-title":"The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia","volume":"7","author":"Frankel HL","year":"1969","unstructured":"Frankel HL, Hancock DO, Hyslop G,  The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. Paraplegia. 1969;7(3):179\u2013192."},{"issue":"3","key":"b15","series-title":"J Neurosurg Spine","first-page":"324","article-title":"Reliability analysis of the epidural spinal cord compression scale","volume":"13","author":"Bilsky MH","year":"2010","unstructured":"Bilsky MH, Laufer I, Fourney DR,  Reliability analysis of the epidural spinal cord compression scale. J Neurosurg Spine. 2010;13(3):324\u2013328."},{"issue":"3","key":"b16","series-title":"Spine (Phila Pa 1976)","first-page":"298","article-title":"Surgical strategy for spinal metastases","volume":"26","author":"Tomita K","year":"2001","unstructured":"Tomita K, Kawahara N, Kobayashi T, Yoshida A, Murakami H, Akamaru T. Surgical strategy for spinal metastases. Spine (Phila Pa 1976). 2001;26(3):298\u2013306."},{"issue":"19","key":"b17","series-title":"Spine (Phila Pa 1976)","first-page":"2186","article-title":"A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis","volume":"30","author":"Tokuhashi Y","year":"2005","unstructured":"Tokuhashi Y, Matsuzaki H, Oda H, Oshima M, Ryu J. A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis. Spine (Phila Pa 1976). 2005;30(19):2186\u20132191."},{"issue":"3","key":"b18","series-title":"Can J Surg","first-page":"188","article-title":"A comparison of the modified Tokuhashi and Tomita scores in determining prognosis for patients afflicted with spinal metastasis","volume":"57","author":"Aoude A","year":"2014","unstructured":"Aoude A, Amiot LP. A comparison of the modified Tokuhashi and Tomita scores in determining prognosis for patients afflicted with spinal metastasis. Can J Surg. 2014;57(3):188\u2013193."},{"issue":"7","key":"b19","series-title":"Spine (Phila Pa 1976)","first-page":"478","article-title":"The \"spinal metastasis invasiveness index\": a novel scoring system to assess surgical invasiveness","volume":"46","author":"Kumar N","year":"2021","unstructured":"Kumar N, Ramos MRD, Patel R,  The \"spinal metastasis invasiveness index\": a novel scoring system to assess surgical invasiveness. Spine (Phila Pa 1976). 2021;46(7):478\u2013485."},{"issue":"5","key":"b20","series-title":"AJNR Am J Neuroradiol","first-page":"920","article-title":"Assessing vascularity of osseous spinal metastases with dual-energy CT-DSA: a pilot study compared with catheter angiography","volume":"40","author":"Huang YC","year":"2019","unstructured":"Huang YC, Tsuang FY, Lee CW, Wu CY, Lin YH. Assessing vascularity of osseous spinal metastases with dual-energy CT-DSA: a pilot study compared with catheter angiography. AJNR Am J Neuroradiol. 2019;40(5):920\u2013925."},{"issue":"4","key":"b21","series-title":"J Formos Med Assoc","first-page":"340","article-title":"Diagnostic performance of computed tomography-digital subtraction angiography and conventional magnetic resonance imaging for evaluating the vascularity of osseous spinal tumors","volume":"124","author":"Liao TW","year":"2025","unstructured":"Liao TW, Lin YH, Tsuang FY, Lee CW, Huang YC. Diagnostic performance of computed tomography-digital subtraction angiography and conventional magnetic resonance imaging for evaluating the vascularity of osseous spinal tumors. J Formos Med Assoc. 2025;124(4):340\u2013347."},{"key":"b22","series-title":"Eur J Radiol","first-page":"111639","article-title":"Association of CT-DSA vascular assessment and perioperative outcomes in metastatic spinal surgery","volume":"178","author":"Tsuang FY","year":"2024","unstructured":"Tsuang FY, Huang YC, Liao TW, Lin YH, Lee CW. Association of CT-DSA vascular assessment and perioperative outcomes in metastatic spinal surgery. Eur J Radiol. 2024;178:111639."},{"issue":"8","key":"b23","series-title":"Spine J","first-page":"1334","article-title":"Preoperative embolization in surgical treatment of spinal metastases originating from non\u2013hypervascular primary tumors: a propensity score matched study using 495 patients","volume":"22","author":"Groot OQ","year":"2022","unstructured":"Groot OQ, van Steijn NJ, Ogink PT,  Preoperative embolization in surgical treatment of spinal metastases originating from non\u2013hypervascular primary tumors: a propensity score matched study using 495 patients. Spine J. 2022;22(8):1334\u20131344."},{"issue":"1","key":"b24","series-title":"J Korean Neurosurg Soc","first-page":"106","article-title":"Clinical significance of preoperative embolization for non-hypervascular metastatic spine tumors","volume":"62","author":"Yoo SL","year":"2019","unstructured":"Yoo SL, Kim YH, Park HY,  Clinical significance of preoperative embolization for non-hypervascular metastatic spine tumors. 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