Oral Presentation 51st International Society for the Study of the Lumbar Spine Annual Meeting 2025

Introduction:

Blood loss is an important consideration in metastatic spine tumour surgery (MSTS). Allogeneic blood transfusion (ABT) is the current standard of blood replenishment for MSTS despite known complications. Salvaged blood transfusion (SBT) through intraoperative cell salvage (IOCS) addresses majority of complications related to ABT. However, use of SBT in MSTS remains controversial. We conducted a prospective propensity-score (PS) matched analysis to evaluate the long-term clinical outcomes of IOCS in MSTS.

Methods
Patients who underwent MSTS from 2014-2017 were included. PS matched cohort of ABT and SBT groups were created using the relevant and available predictors of treatment assignment and outcomes of interest. Clinical outcomes consisting of overall survival (OS), as well tumour progression (TP) that was evaluated using RECIST (v1.1) were analysed.

Results

Our study included 98 patients with a mean age of 60yrs. 33 patients received SBT, 39 received ABT and 26 received NBT. Median blood loss was 400 mL [IQR 200-900 mL] and median BT was 328.5 mL (IQR: 0 – 1042 mL). Group PS matching included 30 patients who received ABT and 28 patients who received SBT. There was also no significant difference between the OS of patients who underwent ABT or SBT (p=0.250). SBT did not show any significant increase in 4-year tumour progression (p=0.908).

Discussion 

SBT has shown to have similar clinical outcomes to that of ABT in patients undergoing MSTS, with benefits of avoiding complications of ABT. This is the first long term PS matched analysis reporting clinical outcomes of SBT, affirming its role and potential for widespread use in MSTS today.