Introduction
Anterior lumbar interbody fusion (ALIF) is a surgical technique used to treat degenerative disc disease.1 The anterior approach is favored as it spares the spinal canal, decreasing the likelihood of neural structure damage.2 The most common complications include deep vein thrombosis (DVT) and pulmonary embolism.3
There is no consensus on the use of perioperative DVT prophylaxis to reduce the risk of thrombotic events during ALIF procedures. DVT prophylaxis may mitigate thrombotic events while increasing the risk of severe bleeding.
The goal of the present study is to assess whether providing perioperative coagulative intervention during ALIF procedures increases risk of complications. Given the rising number of patients undergoing ALIF procedures understanding the impact of perioperative anticoagulation on surgical outcomes is important for improving patient outcomes and reducing surgical risk.4
Methods
A retrospective, single-institution review of medical records of patients that had documentation of anterior lumbar fusion was performed. Demographics, surgical information, medications, and complications were extracted. Pain scores and neurologic deficits at presentation and 1-3 month follow-ups were recorded. Patients were included if their ALIF surgeries were performed at Michigan Medicine. Logistic regressions, ANOVA tests, and Chi-Squared analyses were performed on categorical variables.
Results
One hundred eighty-nine patients were included; there were eighty-six females and an average age of 58.67 +/- 13.26 years. 115 patients received no intervention, 22 patients received subcutaneous heparin (SQH), and 35 patients received tranexamic acid (TXA). There were no statistically significant differences between coagulation intervention and complication rate, change in post-operative motor function (p = 0.1468), or postoperative VAS pain change (p = 0.216, F-value = 1.544). No differences were found between length of hospital stay and coagulation intervention after correcting for staged procedures (p = 0.422, t-value = -0.804). Although not statistically significant (p = 0.071, F-value = 3.306), there seemed to be a decreased estimated blood loss with no intervention, SQH, and TXA, in decreasing order (after stratifying by approach).
Conclusions
The use of perioperative DVT prophylaxis in ALIF procedures did not result in increased complication rates, increased hospital stay, or a statistically significant change in blood loss.
Figure 1
References
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