Introduction. Reported incidence of DVT after spinal surgery ranges from 0-15% and PE 0.5-2.7%. Theoretically, manipulation of the vessels and venous stasis caused by retraction during anterior lumbar inter-body fusion may increase the propensity for thrombosis. The reported incidence of DVT and PE following major abdominal and pelvic surgery are high (up to 23%) and all these patients routinely receive chemical prophylaxis. Aim. Should patients undergoing ALIF surgery receive chemical prophylaxis routinely?. Materials and Methods. Retrospective review of ALIF procedures done between Jan 2007- Jan 2010. Review of case notes, radiology reports and telephone call to the patients to exclude DVT. Total of 76 patients underwent ALIF during this period. Forty six were female(60.5%) and 36 were 2 level fusions(47%). L5-S1 being commonly fused (76%) followed by L4-L5 (23%). Average surgical time from theatre records is 115 minutes(31-369 minutes). All patients received mechanical prophylaxis in the form of thigh length TED stockings. None of the patients were on treatment for DVT prior to surgery. Results. Three patients (3.9%) had Doppler proved DVT which required anticoagulation treatment. There was no reported incidence of PE. Discussion. There is no definite evidence in the literature to suggest ALIF surgery has higher incidence of thromboembolic complications, though theoretical possibility of increased risk. Current study suggests that incidence is 3.9% with mechanical prophylaxis alone which is very small when compared to incidence after major abdominal, pelvic or gynaecological procedures. Our small study sample suggests routine use of chemical prophylaxis to reduce the risk of DVT for anterior lumbar inter-body fusion is not justified

Introduction. Lumbar spinal pain can be a consequence of discogenic pain. After failure of conservative management, lumbar fusions are popular and considered the gold standard. However, these techniques are associated with significant morbidity. A percutaneous trans-sacral technique may address these for L4/L5 and/or L5/S1 alone spinal fusions. Our unit has adopted this technique and presents our initial experience of 51 patients and preliminary results. Method. Patients with a confirmed clinical and radiological evidence of degenerate intervertebral disc with or without prior surgical intervention were selected. Patients with a history of pelvic surgery/radiotherapy were excluded. Data was collected prospectively using the Global Patient Outcome Scoring System and Oswestry Disability Index (ODI) scores at clinical follow-up. Results. 51 patients received the procedure and 30 achieving a minimum of 6 months follow-up. Patients had a median age of 46(range 20-78) and included 19 male and 32 females with on average 40 months of pain. The mean ODI score improved after surgery from pre-operative levels 52.9(SEM 3.0) to 6 month scores of 38.4(SEM 3.9), t(29)=4.2, p<0.0002 . This difference remained statistically significant at 12 month follow-up with a mean ODI scores 34.3 (SEM 5.2), t(18)=4.37, P<0.0004 (Mean difference of 21.1 SEM 4.8). A sub-analysis of confounding factors identified patients with previous surgery, claiming state benefits, pursuing litigation, mainly leg pain and requiring pedicular fusion failed to achieve statistical significance. Patients receiving a 360 degree fusion with facet screws alone improved sooner and achieving a mean difference in ODI score of 27.6(SEM 8.2). Conclusion. Our initial results confirm this to be an effective alternative treatment modality for lumbar spine fusion in the management of primary discogenic back pain. Patients receiving 360 degree fusion and not claiming state benefits or pursuing litigation appear to have a better outcome