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  • Is Deep Venous Thrombosis and Pulmonary Embolism Prophylaxis Needed at all in Patients Undergoing a Cervical Spinal Operation

    Final Number:

    Luke Mugge; Ramneek Dhillon; Nicholas Henkel; Harsh Desai; Tarek R Mansour; Jason L. Schroeder MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: Deep venous thrombosis (DVT) and pulmonary embolism (PE) are major concerns for all post-operative patients who have minimal ambulatory capacity and extended periods of immobility. Given that patients who undergo cervical spine surgery are particularly prone to immobility, having appropriate protocols and understanding prophylaxis as it relates to each patient is essential to avoid these post-operative complications.

    Methods: We undertook a retrospective, IRB approved analysis of patients who underwent either an anterior cervical discectomy and fusion (ACDF) or a posterior cervical discectomy and fusion (PCDF) at the University of Toledo, Medical Center.

    Results: 89 patients were analyzed: 38 underwent ACDF (Group A) and 51 underwent PCDF (Group B), respectively. Group A and B had an average length of stay of 2.97 and 6.12, respectively. In terms of DVT prophylaxis, 3 patients (7.89%) received 5,000 units of SubQ heparin for DVT prophylaxis. For group B, 4 patients (7.84%) received 5,000 units of SubQ heparin and 16 patients (31.4%) received an alternative anti-platelet/anti-coagulate, such as Aspirin, Plavix, Lovenox, or Xarelto, for DVT prophylaxis. When the total number of DVT and PE were examined, it was determined that no patients in group A suffered from either a DVT or a subsequent PE. Within group B, 2 patients where noted to develop a DVT and none developed a PE. For the patients in group B who developed a DVT, one was not being treated with any medical DVT prophylaxis, and the other was being treated with Xarelto.

    Conclusions: This demonstrates that while DVT prophylaxis is central to prevention of PE and other vascular related complications of spine surgery, strict adherences to uniform regiments may not be necessary for prevention of this post-operative complication. Rather, early ambulation and non-medical management may be sufficient at preventing DVTs within this surgical patient population.

    Patient Care: Early ambulation and shorter hospital stay durations may be superior to medical management for preventing DVT and PE in spinal fusion patient populations.

    Learning Objectives: - Prophylaxis prevention of DVT formation is reasonable in the post-operative setting for patients undergoing a cervical spinal fusion - EPC cuffs, sub-q heparin, and ambulation stand as successful prophylactic treatments of DVT - Given the low rate of DVT and PE in cervical fusion patients, EPC cuffs and ambulation may be sufficient for prevention of DVT without use of sub-q heparin

    References: 1) Khaldi A, Helo N, Schneck MJ, Origitano TC. Venous thromboembolism: deep venous thrombosis and pulmonary embolism in a neurosurgical population. J Neurosurg. 2011 Jan;114(1):40-6. doi: 10.3171/2010.8.JNS10332. Epub 2010 Sep 3. PubMed PMID: 20815694. 2) Al-Dujaili TM, Majer CN, Madhoun TE, Kassis SZ, Saleh AA. Deep venous thrombosis in spine surgery patients: incidence and hematoma formation. Int Surg. 2012 Apr-Jun;97(2):150-4. doi: 10.9738/CC71.1. PubMed PMID: 23102081; PubMed Central PMCID: PMC3723201. 3) Papadimitriou K, Amin AG, Kretzer RM, Sciubba DM, Bydon A, Witham TF, Wolinsky JP, Gokaslan ZL, Baaj AA. Thromboembolic events and spinal surgery. J Clin Neurosci. 2012 Dec;19(12):1617-21.

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