Study Design. Retrospective case series.
Objective. To evaluate the safety and efficacy of prophylactic inferior vena cava filter (IVCF) to prevent pulmonary embolism (PE) in high risk patients undergoing major complex spinal surgery.
Summary of Background Data. PE has been reported to be the major cause of death after spinal reconstructive surgery. Mechanical prophylaxis alone is often not sufficient whereas anticoagulation therapy carries a significant risk of bleeding complications. Prophylactic IVCF placement is advocated in high-risk patients.
Methods. A total of 129 high-risk patients undergoing complex spine surgery, having prophylactic IVCF were compared to a matched cohort of age, diagnosis, and risk factors of 193 patients for whom only mechanical prophylaxis was used. Patients were observed for potential complications related to the IVCF and also for clinical signs and symptoms of PE.
Results. Eight cases (4.2%) of symptomatic PE were detected in the matched cohort control group (5 cases having combined anterior + posterior surgery and 3 patients having only posterior surgery). One of them died due to massive PE (0.5%). Symptomatic PE was detected in only 2 patients (1.5%), having combined anterior + posterior surgery due to lumbar spinal stenosis in IVCF group who responded well to medical treatment (P < 0.05). No complications were associated with filter insertion.
Conclusion. Prophylactic IVCF is effective and safe in prevention of pulmonary embolism in patients with risk factors for PE.
One hundred twenty-nine high-risk patients undergoing complex spine surgery, having prophylactic inferior vena cava filter were compared to a matched cohort of age, diagnosis, and risk factors of 193 patients for whom only mechanical prophylaxis was used. Prophylactic inferior vena cava filter is found to be effective and safe in prevention of pulmonary embolism in patients with risk factors for pulmonary embolism.
From the Istanbul Spine Center, Florence Nightingale Hospital, Istanbul, Turkey.
Acknowledgment date: November 17, 2009. Revision date: February 20, 2010. Acceptance date: May 10, 2010.
The manuscript submitted does not contain information about medical device(s)/drug(s).
No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.
Address correspondence and reprint requests to Cagatay Ozturk, MD, Istanbul Spine Center, Florence Nightingale Hospital, Abide-i Hurriyet Caddesi No: 290, 34430 Sisli, Istanbul, Turkey; E-mail: firstname.lastname@example.org