Lightning Podiums: Spinal Potpourri - 803B

Presented by: A. Kasis

Author(s):

A. Kasis(1), H. Vint(1), C. Coe(2), M. Mawdsley(1), C. Jensen(1)

(1) Northumbria NHS Trust, Orthopaedic Spine Surgery, Ashington, United Kingdom
(2) Northumbria NHS Trust, Anaesthetic Department, Ashington, United Kingdom

Abstract

Introduction: Deep vein thrombosis (DVT) and pulmonary embolism (PE) are recognised complications after spine surgery, with rates in the literature ranging from 0.7-5%. Pharmacological thromboprophylaxis can cause post-operative bleeding and haematomas which can result in neural compromise and wound complications. Anterior lumbar spine surgery involves the handling and compression of major abdominal vessels during surgery and this adds to the risk of venous thromboembolism (VTE). Herein we evaluate the incidence of VTE after Anterior Lumbar Interbody Fusion (ALIF) using a combination of mechanical and pharmacological thromboprophylaxis pre- and post-operatively. This regime was adopted from Gold Coast Spine, Australia.

Methods: We carried out a retrospective review of 160 consecutive patients who underwent ALIF for degenerative conditions from 2013-2017. All patients had Low Molecular Weight Heparin (Tinzaparin) 4500 units subcutaneously on the evening before surgery, then daily for 3 to 5 days (whilst an in-patient) and then Aspirin 150 mg daily for 4 weeks after surgery. All patients wore Thrombo-Embolic Deterrent Stockings (TEDS) for a total of 6 weeks from the time of surgery. All patients had intermittent pneumatic compression of their calves and thighs (Flotron) intra-operatively and for 24 hours post-operatively. Patients were mobilised the morning after surgery. All patients were reviewed in the outpatient clinic at 2, 6, 24, and 52 weeks. The records of all patients were reviewed for the incidence of VTE. All patients were contacted by telephone to enquire if they had undergone any VTE investigations or treatments, in case patients had a VTE in between clinic appointments or in other hospitals.

Results: 160 consecutive patients were included in the study. The average age was 44.8 (28-70.3) years. 93 patients were female. The ALIF was performed at L5/S1 in 82 patients, L4/5 in 65 patients, L4/5 and L5/S1 in 11 patients, one patient had revision of ALIF at L5/S1 and one patient had L3/4, L4/5 and L5/S1. 37 patients had surgery for spondylolisthesis, 13 for revision of posterior non-union, 27 for recurrent disc prolapse after discectomy, 48 for loss of disc height and neuroforaminal stenosis and 35 for degenerative disc disease. There was no incidence of any symptomatic VTE in the any of the 160 patients. There was no incidence of wound haematoma or bleeding, and no symptomatic retroperitoneal hematoma requiring intervention. There were 2 superficial wound infections treated with oral antibiotics, one of which required a Negative Pressure Wound Therapy (PICO) dressing for 10 days.

Conclusion: The proposed VTE prophylactic regime is effective in preventing the incidence of symptomatic VTE in patients who underwent an ALIF procedure. Clearly, routine post-operative vein imaging would be needed to confirm the complete absence of VTE using this technique; however we have shown that it led to a reduction in the symptomatic VTE rate following ALIF surgery as compared with the general reported rates in the ALIF literature. In addition to the VTE prophylaxis, we think that minimising the time the abdominal vessels are under tension plays a role in reducing the incidence of VTE, however this was not investigated in this trial.