Interruption of the bilateral segmental arteries at several levels : Influence on vertebral blood flow

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Intraoperative hemorrhage can be sometimes massive in patients with hypervascular spinal tumors, especially in radical resection such as total en bloc spondylectomy. The recent development of new embolization techniques ensures mole aggressive, more extensive, and safer preoperative embolization for spinal tumors. The blood flow of the T12 vertebra of twelve female dogs was measured after ligation of the bilateral segmental arteries at one to three levels, including the T12. Spinal cold evoked potentials were recorded in this procedure. Spinal angiography using a silicon compound was performed on other ten dogs after clipping and section of the bilateral segmental arteries. The blood flow of the T12 vertebra decreased to 70.13±6.37% of the control value after ligation of the bilateral segmental arteries of T12, to 46.48±8.97% after ligation of the bilateral segmental arteries of T12 and either T11 or T13, to 24.±8.31% after ligation of T11, 12 and 13, respectively. The angiogram after ligation and section of T12 and the two levels including T12 showed thick and clear contrast medium in the cut distal ends of the T12 segmental arteries. After interruption at three levels (T11, 12, and 13 level), however, the,cut distal ends of the T12 segmental arteries were seen thin and faint on the angiogram. No significant changes occurred in SCEPs after ligation of the segmental arteries at three levels in all six dogs. Interruption of the bilateral segmental arteries at three levels, one target vertebra and the two adjacent vertebrae, seduced the blood flow of the target vertebra to one forth of the control value in the lower thoracic spine in dogs. This result suggests that preoperative embolization at three levels, the levels of the tumor vertebra and the adjacent vertebrae above and below it, may seduce intraoperative hemorrhage effectively during total en bloc spondylectomy for hypervascular spinal tumors