1570. Examining Venous Thromboembolism Prophylaxis in Cervical Spinal Fusions of Myelopathic and Non-Myelopathic Patients: Is It Necessary?
Authors: Nicholas Henkel; Nicholas Henkel, BA; Harsh Desai; Luke Mugge; Ramneek Dhillon; Jason Schroeder (Toledo, OH)
Deep venous thrombosis (DVT) and pulmonary embolism (PE) are major concerns for all postoperative cervical spinal fusion patients who have minimal ambulatory capacity and extended periods of immobility. Given that patients who undergo cervical spine surgery are particularly prone to immobility, with or without a concomitant diagnosis of myelopathy, having appropriate protocols and understanding prophylaxis as it relates to each patient is essential to avoid these postoperative complications.
We undertook a retrospective, IRB approved analysis of patients who underwent either an anterior cervical discectomy and fusion (ACDF) or a posterior cervical discectomy and fusion (PCDF) at the University of Toledo Medical Center.
104 patients were analyzed: 43 underwent ACDF, 61 underwent PCDF. In total, 39 were myelopathic and 65 were non-myelopathic. The total incidence of either DVT or PE in the ACDF and PCDF populations were 0% and 3.3%, respectively. The onset of VTE was not significantly correlated with surgical technique (R = -0.118; p = 0.235). Of the myelopathic patients, 46.2% received VTE prophylaxis while 23.1% of non-myelopathic patients received prophylaxis. Though the myelopathic patients received more prophylactic care for VTEs (p = 0.020) and anticoagulation therapy (p = 0.026) than their non-myelopathic counterparts, a diagnosis of myelopathy did not correlate with an incidence of VTE (R = 0.036; p = 0.716). Furthermore, PCDF patients received more anticoagulation therapy as heparin administration, antiplatelet therapy, or compression stockings (p < 0.01). However, the rate of VTE was not different.
This demonstrates that while DVT prophylaxis is central to prevention of PE and other vascular related complications of spine surgery, strict adherences to uniform regiments may not be necessary for prevention of this post-operative complication. Rather, early ambulation and non-medical management may be sufficient at preventing DVTs within this surgical patient population.