INCIDENCE OF THROMBOEMBOLIC COMPLICATIONS IN LUMBAR SPINAL SURGERY

Abstract

Introduction: 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 and physical measures had reduced the incidence of clinically evident deep venous thrombosis (DVT) and pulmonary embolism (PE).

Materials and Method: This study was undertaken to investigate the incidence of DVT/PE during the 10 years from 1/1/1985 to 31/12/1994, 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 thromboembolic 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 1/1/1996 to 31/12/2003 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.

Results: Records of a total of 1111 lumbar spine operations were performed from 1/1/1985 to 31/12/2004 were reviewed. The overall incidence of thromboembolic complications was 0.29%. A total of 697 operations were performed from 1/1/1985 to 311994 with two cases of DVT and no cases of PE giving thromboembolic complication rate of 0.29%. During the period 1/1/1996 to 31/12/2003, 414 operations resulted in one case of DVT and no cases of PE, a rate 0f 0.24%.

Conclusion: The incidence of thromboembolic complications is low whether or not anticoagulation is used. We believe that the kneeling, seated prone operating position is a significant contributing factor.