Intraoperative injection of absorbable gelatin sponge (AGS) mixed with cement followed by spinal decompression to treat elderly with vertebral hemangiomas

Abstract

Background: Elderly patients with vertebral hemangiomas are rare and might require surgery. Thus, the choice of surgery for these lesions remains controversial because of the rarity of these lesions. This study aimed to analyze the clinical efficacy of the intraoperative injection of absorbable gelatin sponge mixed with cement followed by spinal decompression to treat the elderly with typical vertebral hemangiomas. The risk factors for hemangioma recurrence were investigated through a literature review. Methods: We retrospectively analyzed 13 patients with typical aggressive hemangiomas between January 2009 and January 2016. Of these patients, 7 were treated with spinal decompression combined with intraoperative vertebroplasty (Group A), and 6 patients were treated with decompression with intraoperative vertebroplasty and absorbable gelatin sponge (Group B). The general data and perioperative data of the patients were compared. Patients were followed up for at least 3 years, and postoperative complications and recurrence rates were recorded and compared. Results: All patients had typical aggressive hemangiomas. The average age of all patients was 64.4 ± 3.3 years. The preoperative data did not differ significantly between the two groups (P > 0.05). The blood loss of groups A and B was 707.1 ± 109.7 ml and 416.7 ± 103.3 ml, respectively (P = 0.003) (P = 0.003), and the average surgery durations were 222 ± 47.8 min and 162 ± 30.2 min, respectively (P = 0.022). The average follow-up duration was 62 ± 19 months, and no cases of recurrence were found at the final follow-up assessment. Conclusions: Multimodal treatment significantly alleviated the clinical symptoms of elderly patients with typical aggressive vertebral hemangiomas. Intraoperative absorbable gelatin sponge injection is a safe and effective way to reduce blood loss and surgery duration.

WITHDRAWN: Aggressive Vertebral Hemangiomas Causing Compression Fracture with Neurological Deficits: A Retrospective Cohort Study

“…In our clinical practice, we used preoperative trans-arterial embolization and intraoperative injection of gelfoam to further reduce blood loss.After injection of gelfoam and cement, the visualization of operative eld was clearer, and the tumor tissue can be removed more effectively and thoroughly. We previously found the intraoperative injection of absorbable gelfoam is associated with fewer blood loss and surgery duration [30]. Because the size of gelfoam particlesare small, the communicating blood vessels of the tumor body can be embolized by the gelfoam particles, and the mixed contrast medium injected at the same step can demonstrate the effect of embolization.…”

Management of Aggressive Vertebral Haemangioma and Assessment of Differentiating Pointers Between Aggressive Vertebral Haemangioma and Metastases – A Systematic Review

“…Ben wang et al 15 Wei hong Xu et al 20 Cloran et al 3 Nair et al 16 Singh et al 19 Prabhuraj et al 18 Narayana et al 17 Zhang et al 21 (14.1%). CT guided alcohol ablation has been offered to those patients presenting with back pain and radicular symptoms or back pain alone 3 (6.0%).…”

“…5,6 Literature documents various management options for AVH including medical management, CT guided alcohol ablation, External beam radiation, Percutaneous vertebroplasty and Surgery with or without preop embolization. 3,16,19,20 Due to the wide array of treatment options, clinicians has decision dilemma in choosing the optimal line of management to maximise patient outcome . Nigro et al 7 in his editorial in Journal of Spine Surgery in the year 2017 has stated that AVH are common lesions with many unknown aspects and with no universal consent in its line of management.…”

Hemostatic Agents in Orthopedic Surgery

“…One study reported a decrease in postoperative drain output and length of hospital stay following the use of absorbable gelatin sponges in multilevel posterior lumbar fusion [39]. When mixed with cement, they can significantly reduce intraoperative blood loss and operative time in patients undergoing spinal decompressions for treatment of vertebral hemangiomas [40]. Preinjection of Gelfoam for embolization is another technique successfully being used in percutaneous vertebroplasties to minimize venous cement leakage [1].…”