THE MORBIDITY OF HEPARIN-THERAPY AFTER DEVELOPMENT OF PULMONARY EMBOLUS IN PATIENTS UNDERGOING THORACOLUMBAR OR LUMBAR SPINAL-FUSION

Study Design. The postoperative course of patients who developed a pul monary embolus after thoracolumbar or lumbar spinal fusion treated wit h heparin was studied to quantify the morbidity risk of anticoagulatio n. Objective. To compare the morbidity risk of heparinization with tha t of an alternative form of therapy-inferior vena cava filter placemen t. Summary of Background Data. Therapeutic heparinization was the curr ent treatment of choice for patients who develop thromboembolic diseas e after surgery. Although heparin usage was reported to be associated with a number of complications after other orthopedic and general surg ical procedures, no information was available to identify complication s of heparinization after lumbar or thoracolumbar spine surgery or to define the risk of such complications. Methods. Twenty-two members of the Scoliosis Research Society were pelted to determine their experien ces with the anticoagulation of this subset of patients. Surgeons poll ed had a combined experience of 250 man-years end had performed more t han 13000 thoracolumbar and lumbar spinal fusions. The MEDLINE databas e was used to review pertinent English language publications describin g inferior vena cava filter complications, effectiveness, safety, and indications for use. Results. Nine patients were located who fit the i nclusion criteria of this study. Six (67%) had complications attributa ble to heparinization. Clinically significant complications of filter placement ranged from 0.12% to 10.1%. Conclusions. Heparinization afte r the development of pulmonary embolus in patients recently undergoing spinal fusion is associated with a high complication rate. The morbid ity of vena cava fitter placement is low and should be considered a tr eatment alternative in the treatment of patients who experience pulmon ary embolus after surgery.