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Incidence of thromboembolic complications in lumbar spinal surgery in 1,111 patients

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Abstract

Deep venous thrombosis (DVT) and pulmonary embolism (PE) cause significant morbidity and mortality in orthopaedic surgical practice, although the incidence following surgery to the lumbosacral spine is less than following lower limb surgery. Our objective was to compare our rate of thromboembolic complications with those published elsewhere and investigate whether the adoption of additional pharmacological measures reduced the incidence of clinically evident DVT and PE. This retrospective study was undertaken to investigate the incidence of DVT/PE during the 10 years from 1 January 1985 to 31 December 1994, and then to assess the effectiveness of an anticoagulant policy introduced during 1995 using low dose aspirin or LMH in high risk cases. All records for spinal operations were reviewed for thrombo-embolic complications by reference to the Scottish Morbidity Record form SMR1. To ensure that all patients were compliant with the policy, data for the whole of 1995 was omitted and the period 1 January 1996 to 31 December 2003 was taken to assess its effectiveness. Surgery was done with the patient in the kneeling, seated prone position which leaves the abdomen free and avoids venous kinking in the legs. Records of a total of 1,111 lumbar spine operations were performed from 1 January 1985 to 31 December 2004 were reviewed. The overall incidence of thrombo-embolic complications was 0.29%. A total of 697 operations were performed from 1 January 1985 to 31 December 1994 with two cases of DVT and no cases of PE giving thromboembolic complication rate of 0.29%. During the period 1 January 1996 to 31 December 2003, 414 operations resulted in one case of DVT and no cases of PE, a rate of 0.24%. The incidence of symptomatic thrombo-embolic complications in lumbar spinal surgery is low in the kneeling, seated prone operating position, whether or not anticoagulation is used.

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References

  1. Balderston RA, Winter RB, Moe JH et al (1986) Fusion to the sacrum for non-paralytic scoliosis in the adult. Spine 11:824–829. doi:10.1097/00007632-198610000-00017

    Article  PubMed  CAS  Google Scholar 

  2. Bardeen A (1995) Special pad for patients in the prone position. Anaesthesiology 16:464–466

    Google Scholar 

  3. Barnett HG, Clifford JR, Llewllyn RC (1977) Safety of mini-dose heparin administration for neurosurgical patients. J Neurosurg 47:27–30. doi:10.3171/jns.1977.47.1.0027

    Article  PubMed  CAS  Google Scholar 

  4. Boachie-Adjei O, Lonstein JE, Winter RB et al (1989) Management of neuromuscular spinal deformities with Luque segmental instrumentation. J Bone Joint Surg 71A:548–562

    Google Scholar 

  5. Bohlman HH, Freehafer A, Dejak J (1985) The results of treatment of acute injuries of the upper spine with paralysis. J Bone Joint Surg 67A:360–369

    Google Scholar 

  6. Bradford DS, Ahmed KB, Moe JH et al (1980) The surgical management of patients with Scheuermann’s disease. J Bone Joint Surg 62A:705–712

    Google Scholar 

  7. Bradford DS, Ganjavian S, Antonious D et al (1982) Anterior strut-grafting for the treatment of kyphosis. J Bone Joint Surg 64A:680–690

    Google Scholar 

  8. Bradford DS, Gotfried Y (1987) Staged reconstruction of grade-IV and V spondylolisthesis. J Bone Joint Surg 69A:191–202

    Google Scholar 

  9. Bradford DS (1979) Treatment of severe spondylolisthesis: a combined approach for reduction and stabilisation. Spine 4:423–429. doi:10.1097/00007632-197909000-00006

    Article  PubMed  CAS  Google Scholar 

  10. Byrd JA, Scoles PV, Winter RB et al (1987) Adult idiopathic scoliosis treated by anterior and posterior spinal fusion. J Bone Joint Surg 69A:843–850

    Google Scholar 

  11. Cerrato D, Cesare A, Fiacchino F (1978) Deep vein thrombosis and low-dose heparin prophylaxis in neurosurgical patients. J Neurosurg 49:378–381. doi:10.3171/jns.1978.49.3.0378

    Article  PubMed  CAS  Google Scholar 

  12. Convery FR, Minteer MA, Smith RW et al (1978) Fracture-dislocation of the dorsal-lumbar spine. Spine 3:160–166. doi:10.1097/00007632-197806000-00012

    Article  PubMed  CAS  Google Scholar 

  13. Cook AW, Siddiqi TS, Nidzgorski R et al (1982) Sitting prone position for the posterior surgical approach to the spine and posterior fossa. J Neurosurg 10:232–235. doi:10.1097/00006123-198202000-00010

    Article  CAS  Google Scholar 

  14. Cotler HB, Cotler JM, Stolff A et al (1985) The use of autografts for vertebral body replacement of the thoracic and lumbar spine. Spine 10:748–756. doi:10.1097/00007632-198510000-00010

    Article  PubMed  CAS  Google Scholar 

  15. DeWald RL, Bridwell KH, Prodromas C et al (1985) Reconstructive spinal surgery as palliation for metastatic malignancies of the spine. Spine 10:21–26. doi:10.1097/00007632-198501000-00004

    Article  PubMed  CAS  Google Scholar 

  16. Dick W (1987) The “fixatuer interne” as a versatile implant for spine surgery. Spine 12:882–900. doi:10.1097/00007632-198711000-00009

    Article  PubMed  CAS  Google Scholar 

  17. Diricco G, Marini C, Rindi M et al (1984) Pulmonary embolism in neurosurgical patients: diagnosis and treatment. J Neurosurg 60:972–975

    Article  CAS  Google Scholar 

  18. Distephano VJ, Klein KS, Nixon JE (1974) Intraoperative analysis of position and body habitus on surgery of the low back. Clin Orthop Relat Res 99:51–56. doi:10.1097/00003086-197403000-00005

    Article  Google Scholar 

  19. Ecker A (1949) Kneeling position for operations on the lumbar spine. Especially for protruded intervertebral disc. Surgery 25:112

    PubMed  CAS  Google Scholar 

  20. Eie N, Solgaard T, Kleppe H (1983) The knee - elbow position in lumbar disc surgery: a review of complications. Spine 8:897–900. doi:10.1097/00007632-198311000-00014

    Article  PubMed  CAS  Google Scholar 

  21. Falconer MA, Mcgeorge M, Begg CA (1948) Surgery of lumbar intervertebral disc protrusion. Br J Surg 139:225–249. doi:10.1002/bjs.18003513902

    Article  Google Scholar 

  22. Ferree BA, Wright AM (1993) Deep venous thrombosis following posterior lumbar spinal surgery. Spine 18(8):1079–1082. doi:10.1097/00007632-199306150-00019

    Article  PubMed  CAS  Google Scholar 

  23. Ferree BA (1994) Deep venous thrombosis following lumbar laminotomy and laminectomy. Orthopaedics 17(1):35–38

    CAS  Google Scholar 

  24. Flesch JR, Leider LL, Erikson DL et al (1977) Harrington instrumentation and spine fusion for unstable fractures and fracture-dislocations of the thoracic and lumbar spine. J Bone Joint Surg 59A:143–153

    Google Scholar 

  25. Hanley EN (1986) Decompression and distraction derotation arthrodesis for degenerative spondylolisthesis. Spine 11:269–276. doi:10.1097/00007632-198604000-00015

    Article  PubMed  Google Scholar 

  26. Hunter AR (1950) Anaesthesia for operations in the vertebral canal. Anaesthesiology 12:367–373

    Article  Google Scholar 

  27. Joffe SN (1984) Incidence of postoperative deep vein thrombosis in neurosurgical patients. J Neurosurg 60:972–975

    Article  Google Scholar 

  28. Kostuik JP (1990) Adult scoliosis. In: Weinstein JS, Wiesel SW (eds) The lumbar spine. W.B. Saunders, Philadelphia, pp 882–915

  29. Lipton S (1950) Anaesthesia in the surgery of retropulsed vertebral discs. Anaesthesia 5:208–212. doi:10.1111/j.1365-2044.1950.tb12685.x

    Article  PubMed  CAS  Google Scholar 

  30. Lonstein JE, Winter RB, Moe JH et al (1980) Neurologic deficits secondary to spinal deformity: a review of the literature and report of 43 cases. Spine 5:331–355. doi:10.1097/00007632-198007000-00007

    Article  PubMed  CAS  Google Scholar 

  31. Love JE, Camp JD (1937) Root pain resulting from intraspinal protrusion of intervertebral discs. Diagnosis and treatment. J Bone Joint Surg 19B:776–803

    Google Scholar 

  32. Malcolm BW, Bradford DS, Winter RB et al (1981) Post-traumatic kyphosis. J Bone Joint Surg 63A:891–899

    Google Scholar 

  33. McEvoy RD, Bradford DS (1985) The management of burst fractures of the thoracic and lumbar spine experience in 53 patients. Spine 10:631–637. doi:10.1097/00007632-198509000-00007

    Article  PubMed  CAS  Google Scholar 

  34. Mielke CH, Lonstein JE, Denis F et al (1989) Surgical treatment of adolescent idiopathic scoliosis. J Bone Joint Surg 71A:1170–1177

    Google Scholar 

  35. Moore DC, Edmonds LH (1950) Prone position frame. Surgery 27:276–279

    PubMed  CAS  Google Scholar 

  36. Nitikman G (1946) Spinal anaesthesia for operation on the vertebral column. Anesth Analg 25:52–57

    Google Scholar 

  37. Rokito SE, Schwartz MC, Neuwirth MG (1996) Deep vein thrombosis after major reconstructive spinal surgery. Spine 21:853–859. doi:10.1097/00007632-199604010-00016

    Article  PubMed  CAS  Google Scholar 

  38. Ryan DW, Pelosi P (1996) The prone position in acute respiratory distress syndrome. BMJ 312:860–861

    PubMed  CAS  Google Scholar 

  39. ADeF Smith, Deery EM, Hagman GL (1944) Herniation of the nucleus pulposus. A study of one hundred cases treated by operation. J Bone Joint Surg 26B:821–828

    Google Scholar 

  40. Smith MD, Bressler EL et al (1994) Deep venous thrombosis and pulmonary embolism after major reconstructive operations on the spine. J Bone Joint Surg 76A(7):980–985

    Google Scholar 

  41. Smith RH, Gramling ZW, Volpitto PP (1961) Problems related to the prone position for surgical operations. Anaesthesiology 22:189–193

    Google Scholar 

  42. Swann KW, Black Pmc L (1984) Deep vein thrombosis and pulmonary emboli in neurosurgical patients: a review. J Neurosurg 61:1055–1062

    Article  PubMed  CAS  Google Scholar 

  43. Tarlov IM (1967) The knee–chest position for lower spinal operations. J Bone Joint Surg 49A:1193–1194

    Google Scholar 

  44. Taylor AR, Gleadhill CA, Bilsand WL (1956) Posture and anaesthesia for spinal operations with special reference to intervertebral disc surgery. Br J Anaesth 28:213–219. doi:10.1093/bja/28.5.213

    Article  PubMed  CAS  Google Scholar 

  45. Wayne SJ (1984) A modification of the tuck position for lumbar spine surgery. A 15-year follow up study. Clin Orthop 184:2121–2216

    Google Scholar 

  46. West JLIII, Anderson LD (1992) Incidence of deep vein thrombosis in major adult spinal surgery. Spine 17:S254–S257. doi:10.1097/00007632-199208001-00007

    Article  PubMed  Google Scholar 

  47. Young JVI, Anderton JM, Keen RI, Neave R (1988) Positioning the surgical patient. Butterworths, London, p 90

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Correspondence to Douglas Wardlaw.

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Nicol, M., Sun, Y., Craig, N. et al. Incidence of thromboembolic complications in lumbar spinal surgery in 1,111 patients. Eur Spine J 18, 1548–1552 (2009). https://doi.org/10.1007/s00586-009-1035-4

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  • DOI: https://doi.org/10.1007/s00586-009-1035-4

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