Eskildsen Scott M, Moll Stephan, Lim Moe R
Departments of *Orthopaedic Surgery †Hematology, University of North Carolina, Chapel Hill, NC.
J Spinal Disord Tech. 2015 Oct;28(8):275-81. doi: 10.1097/BSD.0000000000000321.
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.
静脉血栓栓塞症（VTE）是脊柱手术中一种潜在的严重且危及生命的并发症。然而，脊柱手术中VTE的发生率及预防措施仍存在争议。当前关于VTE预防的建议将“脊柱手术”视为一个单一的宽泛类别，在确定风险时主要考虑患者因素。我们进行了一项文献综述，以确定脊柱手术中不同的VTE和出血风险，从而制定个性化的预防方案。我们的综述表明，美国神经外科医师协会（NASS）和美国胸科医师学会（ACCP）目前关于脊柱手术VTE预防的指南并不理想。在选择VTE预防方法时，考虑（1）与患者相关的VTE风险、（2）与手术相关的VTE风险以及（3）出血并发症导致神经功能受损的风险，将能更恰当地平衡安全性和有效性。为了更好地实现VTE预防的个性化，我们开发了VTE预防风险/效益评分系统，该系统考虑了目前可得的最佳证据，从而得出关于最适合的VTE预防形式的建议。该方案可为外科医生提供参考，以帮助其做出更细致、个性化的预防决策。
