NARRATIVE REVIEWAn Algorithmic Approach to Venous Thromboembolism Prophylaxis in Spine SurgeryEskildsen, Scott M. MD*; Moll, Stephan MD†; Lim, Moe R. MD*Author Information Departments of *Orthopaedic Surgery †Hematology, University of North Carolina, Chapel Hill, NC The authors declare no conflict of interest. Reprints: Scott M. Eskildsen, MD, Department of Orthopaedic Surgery, University of North Carolina, 130 Mason Farm Rd #3155, Chapel Hill, NC 27599 (e-mail: [email protected]) Received April 27, 2015 Accepted July 24, 2015 Journal of Spinal Disorders and Techniques: October 2015 - Volume 28 - Issue 8 - p 275-281 doi: 10.1097/BSD.0000000000000321 Buy Metrics Abstract Venous thromboembolic embolism (VTE) is a potentially serious and life-threatening complication in spine surgery. However, VTE incidence and prophylaxis in spine surgery remains controversial. Current recommendations for VTE prophylaxis address “spine surgery” as a single broad category and mainly consider patient factors when determining risk. We performed a literature review to determine the varying VTE and bleeding risks within spine surgery to develop an individualized prophylactic algorithm. Our review suggests that the current guidelines on VTE prophylaxis for spine surgery from NASS and ACCP are suboptimal. Consideration of (1) patient-related VTE risks, (2) procedure-related VTE risks, and (3) the risk of neurological compromise from bleeding complications will more appropriately balance safety and effectiveness when choosing a VTE prophylaxis method. To better individualize VTE prophylaxis, we have developed the VTE Prophylaxis Risk/Benefit Score that considers this currently available best evidence to arrive at a recommendation for the most appropriate form of VTE prophylaxis. This algorithm informs the surgeon to help make a more nuanced and individualized determination of prophylaxis. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.