Prevention of postoperative DVT after spinal surgery

Although the rate of symptomatic DVT after routine elective spinal surgery is fairly low, however, a significant number of pulmonary emboli circumstances become fatal (%6).Most of prioperative DVT complications are asymptomatic and probably clinicallyinsignificant. Therefore, routine preoperative or postoperative DVT screening withUS or venography is not recommended even at the highest risk for VTE includingspinal cord injury.To prevent the formation of DVT following lumbar spine procedures, surgeons oftenimplement one or several different prophylactic measures ranging from mechanicalcompression stockings or pneumatic sleeves to pharmacologic anticoagulation.Nevertheless, there is still no Level-I evidence establishing the superiority of oneparticular treatment nor is there a universally accepted protocol defining theindications, timing, or duration of treatment. Generally, IPC plus compressionstocking should be used as a primary method of prophylaxis in most elective cases.There is insufficient evidence to support or refuteThe use of chemical anticoagulants in routine electivespinal surgery. Assessment of risk factors, contributing in VTE, is needed to properlydefined in order to determine the true incidence of DVT in high-risk patients, andwhether chemical prophylaxis is indicated. Even though, the prevalence of clinicallyimportant bleeding with chemical prophylaxis is relatively low, permanent neurologicdeficits arising from compression of the neural elements as a consequence of thesedrugs have been reported. Consequently, chemical prophylaxis is suggested primarilyfor the spinal surgery cases with additional thromboembolic risk factors.