Prophylactic placement of an inferior vena cava filter in high-risk patients undergoing spinal reconstruction
Pulmonary embolism is a significant cause of morbidity and mortality after spine surgery. Multiple prophylactic measures have been suggested and include venous compression boots, subcutaneously administered heparin, and early ambulation to prevent DVT. In complex spine surgery, the current practice for postoperative DVT prophylaxis depends primarily on the surgeon and institution. Mechanical prophylaxis alone is often not sufficient, whereas anticoagulation therapy carries a significant risk of
... significant risk of bleeding complications. 10,50 The treatment of PE often involves mandated systemic anticoagulation therapy. Specifically in spine surgery, anticoagulation with heparin may be associated with complications in up to 67% of patients. 10 As an alternative to this treatment, IVC filters have been demonstrated to prevent PE in selected patients who are prone to thromboembolic disorders. Furthermore, the indications have expanded as easier insertion techniques have resulted in lower complication rates. 31, 44, 64 In this paper we describe a select group of patients at two in-stitutions who underwent major spine reconstruction and were considered at high risk for development of a thromboembolic event. The preoperative IVC filter concept was prospectively evaluated at the initial institution, with encouraging results. The treatment guidelines were subsequently implemented at a second institution for further evaluation. CLINICAL MATERIAL AND METHODS Study Design A group of high-risk patients undergoing complex spine surgery was studied prospectively to evaluate the role of prophylactic filters in the IVC. A matched cohort was reviewed retrospectively for the presence of PE. The treatment guidelines were implemented at a second institution for data verification.