Thromboprophylaxis in Spinal Surgeries – Common Complication or Rare Condition?
If you’ve been recommended to undergo spinal surgery for chronic back pain, the risk of complications is an important factor to take into account. In surgery, including spine surgery, deep vein thrombosis is a possible complication and area of concern for many patients.
Surgical treatment for conditions like spinal stenosis and spondylosis presents a far lower risk of complications like DVT when compared to joint replacement surgery. However, thromboprophylaxis in spinal surgeries may be required in some cases.
Here, we’ll discuss the prevalence of DVT in spine surgery and when thromboprophylaxis may be needed.
Prophylaxis is defined as any action that’s done to prevent disease. So, thromboprophylaxis refers to the treatment implemented to prevent thrombosis. There are three possible ways to perform thromboprophylaxis: chemical (pharmacological), mechanical, or a combination of both.
Chemical thromboprophylaxis generally involves the use of medications called blood thinners or clot busters. Aspirin (which prevents platelet aggregation), warfarin, and heparin are the most commonly used blood thinners for thromboprophylaxis, others may also be used.
Blood thinners are also called anticoagulants. These medications can prevent blood clots from forming in the first place. For patients who have experienced a blood clot, blood thinners can help keep the clot from returning.
Also called thrombolytics, clot busters are medications that are administered via IV or a catheter that’s placed into the clot. They work by dismantling blood clots. Common clot busters include alteplase, anistreplase, reteplase, and streptokinase, among others.
Mechanical thromboprophylaxis is another option for preventing thrombosis in spinal surgery and other settings. There are two key types of mechanical thromboprophylaxis: static systems and dynamical systems.
- Static systems
Static systems for mechanical thromboprophylaxis typically involve compression stockings. Also referred to as anti-embolism stockings or elastic stockings, these garments prevent thrombosis by gently encouraging circulation in an upward direction.
- Dynamical systems
Dynamical systems for mechanical thromboprophylaxis include a venous foot pump and intermittent pneumatic compression.
Deep Vein Thrombosis
Deep vein thrombosis (DVT) is a possible complication of spinal surgery, as well as a variety of other surgical procedures. DVT is a condition that results from a blood clot that develops in one of the body’s deep veins. In most cases, DVT arises in the leg.
A lack of physical motion for an extended period after surgery can trigger DVT. A long stay in the hospital following spine surgery can also contribute to this medical complication.
Signs of thrombosis include:
- Sharp chest pain
- Swelling in the feet and affected leg
- Rapid shortness of breath
- Dizziness and fainting
- Rapid pulse
- Coughing up blood
Risk Factors For DVT
Along with a lack of motion (muscle atony), certain factors can increase your risk of developing thrombosis after surgery, including:
- Older age
- Previous surgeries
- Being overweight
- Oral contraceptives and hormone replacement therapy
- Genetics, including genetic disorders like factor V Leiden
- A family history of DVT
- Heart failure
- Bowel conditions, including inflammatory bowel disease, Crohn’s disease, and ulcerative colitis
How Common is Thrombosis in Spinal Surgery?
Without thromboprophylaxis, an estimated 15% of patients who undergo posterior spinal surgery experience deep vein thrombosis. This may be influenced by the prevalence of venous thromboembolism, or VTE, among patients with degenerative spine conditions.
Thromboprophylaxis can significantly decrease the rate of DVT among spine surgery patients. If you’re at a heightened risk of blood clots or have a severe spinal disorder, your doctor may recommend blood-thinning medications (chemical thromboprophylaxis) for a period to lower your DVT risk.
Patients who don’t need to go on blood thinners may instead use mechanical thromboprophylaxis to prevent thrombosis. Wearing stockings or using a pump to compress your legs can effectively reduce your DVT risk. Standing and moving around as much as possible after surgery is also crucial to warding off postoperative blood clots.
Lowering Your Risk of DVT in Spine Surgery
Spine Surgery Preparation
Effectively preparing for spine surgery can help reduce your risk of developing DVT. Surgery preparation tips to follow include:
- Quit smoking.
Smoking increases the risk of all surgical complications, including DVT. But, in relation to blood clots, nicotine alters the surface of the platelets in the blood. As a result, the platelets become more prone to clumping, potentially leading to blood clots.
- Discuss medications with your doctor.
Before undergoing spinal surgery, make sure to talk to your doctor about all of the medications that you’re currently taking. Your doctor can advise you to stop taking medications that may compromise your recovery and/or increase your risk of complications.
- Eat a healthy diet.
Taking extra care of your nutrition leading up to spinal surgery can help reduce your risk of complications. In particular, make sure to eat plenty of fiber-rich foods, such as vegetables, berries, beans, and whole grains. Fiber can prevent intestinal inflammation and the risks that it poses.
Minimally-Invasive Spine Surgery
Traditional spinal decompression surgery involves spinal fusion. In fusion, two (or more) vertebrae are fused into a single bone using bone graft material.
Unfortunately, spinal fusion greatly increases patients’ recovery time and post-operative pain. Fusion is also associated with a higher risk of medical complications, including DVT.
When compared to fusion, minimally-invasive spine surgery comes with a much lower risk of DVT. So, for spinal stenosis, spondylolisthesis, herniated discs, and other spinal disorders, minimally-invasive surgery (MIS) is an optimal choice to reduce your risk of DVT.
Spinal implants like the TOPS System can allow for minimally-invasive spine surgery. As a spinal fusion alternative, the TOPS System stabilizes the spine while preserving the patient’s range of motion.
Deep vein thrombosis is considered a rare complication of spinal surgery, especially among otherwise healthy patients. But, along with pre-operative preparation and thromboprophylaxis, minimally-invasive spine surgery can largely reduce your risk of developing a blood clot.
Advanced spinal implants like the TOPS System can make it possible to achieve back pain relief and correct spinal deformities without fusion. Talk to your doctor to learn more about the minimally-invasive spine surgery options available to you.