Incidence of thromboembolic complications in lumbar spinal surgery in 1,111 patients

Nicol, Malcolm; Sun, Yu; Craig, Niall; Wardlaw, Douglas

doi:10.1007/s00586-009-1035-4

Cited by 59 publications

(61 citation statements)

References 41 publications

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“…26 Nicol et al recommends kneeling or seated position to prevent venous thromboembolism during spinal surgery, as this reduces venous kinking in the lower extremities. 28 …”

Section: Recommendationsmentioning

confidence: 99%

The Prone Position During Surgery and its Complications: A Systematic Review and Evidence-Based Guidelines

Kwee

Rozen

2015

International Surgery

215

162

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Surgery in the prone position is often a necessity when access to posterior anatomic structures is required. However, many complications are known to be associated with this type of surgery, as physiologic changes occur with increased pressure to anterior structures. While several studies have discussed postoperative vision loss, much fewer studies with lower levels of evidence have addressed other complications. A systematic literature review was conducted using 2 different databases, and 53 papers were regarded as appropriate for inclusion. Qualitative and quantitative analysis was performed. Thirteen complications were identified. Postoperative vision loss and cardiovascular complications, including hypovolemia and cardiac arrest, had the most number of studies and highest level of evidence. Careful planning for optimal positioning, padding, timing, as well as increased vigilance are evidence-based recommendations where operative prone positioning is required.

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“…26 Nicol et al recommends kneeling or seated position to prevent venous thromboembolism during spinal surgery, as this reduces venous kinking in the lower extremities. 28 …”

Section: Recommendationsmentioning

confidence: 99%

The Prone Position During Surgery and its Complications: A Systematic Review and Evidence-Based Guidelines

Kwee

Rozen

2015

International Surgery

215

162

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“…Twentyfour studies performed surgery in the prone position (Table 1), and 7 studies investigated complications following lumbar spine surgery in the knee-chest position (Table 2). 1,2,[5][6][7][9][10][11]13,15,18,19,[21][22][23][24][25][26]28,29,[32][33][34]36,37,39,40,42,[46][47][48] Complications related to the knee-elbow, lateral decubitus, and supine positions were each reported by a single study (Table 3). 14,30,31 prone-position studies Vision loss was the most commonly reported complication, with 11 case reports describing postoperative-onset vision loss.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…4 Complications related to positioning during lumbar spine surgery are typically analyzed from an institutional perspective. 14,26,29,46 A systematic review of complications following the numerous positioning options for lumbar spine surgery has not been previously performed. The goal of the present study is to educate the surgical team on avoiding intraoperative positioning complications, thereby improving patient outcomes.…”

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confidence: 99%

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Lumbar spine surgery positioning complications: a systematic review

Shriver

Zeer

Alentado

et al. 2015

FOC

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OBJECT There are a variety of surgical positions that provide optimal exposure of the dorsal lumbar spine. These include the prone, kneeling, knee-chest, knee-elbow, and lateral decubitus positions. All are positions that facilitate exposure of the spine. Each position, however, is associated with an array of unique complications that result from excessive pressure applied to the torso or extremities. The authors reviewed clinical studies reporting complications that arose from positioning of the patient during dorsal exposures of the lumbar spine. METHODS MEDLINE, Scopus, and Web of Science database searches were performed to find clinical studies reporting complications associated with positioning during lumbar spine surgery. For articles meeting inclusion criteria, the following information was obtained: publication year, study design, sample size, age, operative time, type of surgery, surgical position, frame or table type, complications associated with positioning, time to first observed complication, long-term outcomes, and evidence-based recommendations for complication avoidance. RESULTS Of 3898 articles retrieved from MEDLINE, Scopus, and Web of Science, 34 met inclusion criteria. Twenty-four studies reported complications associated with use of the prone position, and 7 studies investigated complications after knee-chest positioning. Complications associated with the knee-elbow, lateral decubitus, and supine positions were each reported by a single study. Vision loss was the most commonly reported complication for both prone and knee-chest positioning. Several other complications were reported, including conjunctival swelling, Ischemic orbital compartment syndrome, nerve palsies, thromboembolic complications, pressure sores, lower extremity compartment syndrome, and shoulder dislocation, highlighting the assortment of possible complications following different surgical positions. For prone-position studies, there was a relationship between increased operation time and position complications. Only 3 prone-position studies reported complications following procedures of less than 120 minutes, 7 studies reported complications following mean operative times of 121–240 minutes, and 9 additional studies reported complications following mean operative times greater than 240 minutes. This relationship was not observed for knee-chest and other surgical positions. CONCLUSIONS This work presents a systematic review of positioning-related complications following prone, knee-chest, and other positions used for lumbar spine surgery. Numerous evidence-based recommendations for avoidance of these potentially severe complications associated with intraoperative positioning are discussed. This investigation may serve as a framework to educate the surgical team and decrease rates of intraoperative positioning complications.

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“…In surgery of the lumbosacral spinal, the lowest quoted rates are 0.6% for DVT and 0.3% for PE. 3 The precise indications and/or timing of anticoagulation for thromboembolic prophylaxis following spinal surgery is not clear. 4 Neurosurgeons must weigh the benefits of DVT prophylaxis against the risk of bleeding complications.…”

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confidence: 99%

Deep Venous Thrombosis in Spine Surgery Patients: Incidence and Hematoma Formation

Aldujaili

Majer

Madhoun

et al. 2012

International Surgery

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Deep venous thrombosis (DVT) is a significant health care problem; a variety of factors place spinal surgery patients at high risk for DVT. Our aim is to define the incidence of DVT occurrence in spite of prophylactic measures (mechanical and chemoprophylaxis), and the development of spinal epidural hematoma as a complication of chemoprophylaxis. In a single-center prospective study, 158 patients who underwent spinal surgical procedures were evaluated by clinical evaluation and lower limb Doppler ultrasonography imaging. Only one patient (0.6%) developed DVT; this patient was treated successfully without thrombus progression, with full recanalization. Three patients (1.8%) developed spinal epidural hematoma, but only one required surgical evacuation, and none sustained neurologic deficit. Careful evaluation for DVT risk on an individual basis and good prophylaxis helps to minimize the risk of DVT. The neurosurgeon is thus left to weigh the risks of postoperative hematoma formation against the benefits of protecting against DVT.Key words: Deep venous thrombosis -Pulmonary embolism -Spinal surgery -DVT prophylaxis -Low molecular weight heparin -Doppler ultrasonography D eep venous thrombosis (DVT) is a significant health care problem, causing considerable mortality and morbidity; it occurs both in medical and surgical patients. DVT is the most frequent systemic complication in patients undergoing neurosurgery. 1 Pulmonary embolism (PE) can still be fatal. 2As the complexity of spinal surgery has increased, so too has the incidence of DVT and PE. In spite of the use of different prophylactic methods, venous thromboembolism (VTE) is still a significant complication following spinal surgery. In surgery of the lumbosacral spinal, the lowest quoted rates are 0.6% for DVT and 0.3% for PE. 3The precise indications and/or timing of anticoagulation for thromboembolic prophylaxis following spinal surgery is not clear. 4 Neurosurgeons must weigh the benefits of DVT prophylaxis against the risk of bleeding complications. Unfortunately, no consensus has been reached regarding a DVT prophylaxis regimen. 5Reprint requests: Thair

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Incidence of thromboembolic complications in lumbar spinal surgery in 1,111 patients

Cited by 59 publications

References 41 publications

The Prone Position During Surgery and its Complications: A Systematic Review and Evidence-Based Guidelines

The Prone Position During Surgery and its Complications: A Systematic Review and Evidence-Based Guidelines

Lumbar spine surgery positioning complications: a systematic review

Deep Venous Thrombosis in Spine Surgery Patients: Incidence and Hematoma Formation

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