Prevention of venous thromboembolism in spinal surgery.

Deep vein thrombosis (DVT), and its most feared complication, pulmonary embolism (PE), still have a high incidence with high risk for patients' health. Proven prophylactic measures are available but are generally underused, and DVT is still considered the most common cause of preventable death among hospitalized patients. The rationale for prophylaxis of venous thromboembolism is based on the clinically silent nature of the disease, the relatively high prevalence among hospitalized patients and the potentially tragic consequences of a missed diagnosis. During the last 15-20 years, spine surgery has changed radically, developing into a well-defined area of specialist surgery, and some attention is now being given to DVT events in spine surgery. The incidence of DVT during spine surgery is not documented in the literature, because only case reports or retrospective studies are reported. It would therefore be very helpful to initiate a multicenter study in order to understand this problem better and to develop, if possible, some guidelines on prophylactic measures in spine surgery. In doing so, we need to consider each patient's pattern, any risk factors and every kind of surgical technique related to DVT, in order to improve the outcome of the patient and to reduce any medicolegal problems that could arise from a thrombotic complication or an epidural hematoma, with its high potential for irreversible consequences.

Elastic stabilization alone or combined with rigid fusion in spinal surgery: a biomechanical study and clinical experience based on 82 cases.

The authors report their experience with the treatment of lumbar instability by a kind of spine stabilization. The elastic stabilization, which follows a new philosophy, is obtained by an interspinous device, and should be used alone in degenerative disc disease, recurrent disc herniation and in very low grade instability, or in association with rigid fusion for the prevention of pathology of the border area. In collaboration with bioengineers, we carried out an experimental study on a lumbar spine model in order to calculate stresses and deformations of lumbar disc during simulation of motion, in physiological conditions and when elastic stabilization is combined with rigid fusion. Results suggest that elastic stabilization reduces stresses on the adjacent disc up to 28 degrees of flexion. Based on this preliminary result, we began to use elastic stabilization alone or combined with fusion in 1994. To date, we have performed 82 surgical procedures, 57 using stabilization alone and 25 combined with fusion, in patients affected by degenerative disc disease, disc herniation, recurrence of disc herniation or other pathologies. Clinical results are satisfactory, especially in the group of patients affected by recurrent disc herniation, in whom the elastic device was used alone.