Paraplegia After Preoperative Embolization of Spinal Metastases: A Case Report

Abstract

Objective: Metastases of the vertebral column can be hyper vascular and may result in severe blood loss during surgery. Preoperative embolization is a technique to reduce the perioperative blood loss. A rare complication of preoperative embolization of spinal metastases is ischemia of the spinal cord. In this case report we present the occurrence of spinal cord ischemia after preoperative embolization of spinal metastases. Methods: Case report. Results: A 66-year old man with short lasting back pain and thoracic radicular pain resented at our neurosurgery department. Neurological examination revealed slight weakness of the left iliopsoas muscle, Medical Research Council (MRC) grade 4 and pathological plantar reflexes. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed metastases of the vertebral body at level L4 and T3. The primary malignancy was found to be a renal cell carcinoma of the left kidney. Corpectomy of T3 and L4 was preceded by preoperative embolization of the segmental arteries at level T2-T4 and L3-L5 on both sides. After embolization there was progressive loss of motor function and relatively limited loss of sensory function, ultimately resulting in complete loss of motor function. Urgent surgery with corpectomy on both levels and circumferential spondylodesis was performed without improvement of neurological deficit. Magnetic resonance imaging one day post-surgery revealed spinal ischemia at the level of T2 and T3. Conclusions: Spinal cord ischemia is a rare, yet severe, complication of preoperative embolization of spinal metastases. Complications of embolization should be weighed against surgical complications in patients without preoperative embolization.