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Thromboembolic disease in spinal surgery: a systematic review
Michael P Glotzbecker1, Christopher M Bono, Kirkham B Wood
1Harvard Combined Orthopaedic Residency Program and Harvard Medical School, Boston, MA, USA.
Spine
|January 31, 2009
Summary
The risk of deep venous thrombosis (DVT) after spinal surgery is generally low. Compression stockings and sequential compression devices appear to be reasonable primary prophylaxis methods.
Area of Science:
- Orthopedic Surgery
- Vascular Surgery
- Thromboembolic Disease
Background:
- Thromboembolic disease risk is established for many orthopedic procedures.
- Incidence of postoperative thromboembolic disease is less defined for spinal surgery.
Purpose of the Study:
- To determine the incidence of thromboembolic disease in postoperative spinal patients.
- To establish a baseline for developing effective prophylaxis protocols.
Main Methods:
- Systematic literature review and pooled data analysis.
- MEDLINE database queried for DVT and spinal surgery terms.
- Data extracted and analyzed by summation to stratify rates.
Main Results:
- Twenty-five articles reviewed; DVT risk varied from 0.3% to 31%.
- Overall DVT rate was 2.1%, influenced by prophylaxis and diagnostic methods.
- Prophylaxis methods showed varied DVT rates, from 0.6% (chemical anticoagulants) to 22% (IVC filters).
Conclusions:
- Compression stockings with sequential compression devices are reasonable primary prophylaxis for routine elective spinal surgery.
- Insufficient evidence exists for routine use of chemical anticoagulants or screening via ultrasound/venogram.
- Further research is needed to refine prophylaxis protocols for spinal surgery patients.
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