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Muthu S, Mavrovounis G, Corluka S, Buser Z, Brodano GB, Wu Y, Meisel HJ, Wang J, Yoon ST, Demetriades AK. Does the choice of chemoprophylaxis affect the prevention of deep vein thrombosis in lumbar fusion surgery? A systematic review of the literature. BRAIN & SPINE 2023; 3:102711. [PMID: 38021015 PMCID: PMC10668088 DOI: 10.1016/j.bas.2023.102711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 11/07/2023] [Indexed: 12/01/2023]
Abstract
Introduction To date, the available guidance on venous thromboembolism (VTE) prevention in elective lumbar fusion surgery is largely open to surgeon interpretation and preference without any specific suggested chemoprophylactic regimen. Research question This study aimed to comparatively analyze the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) with the use of commonly employed chemoprophylactic agents such as unfractionated heparin (UH) and low molecular weight heparin (LMWH) in lumbar fusion surgery. Material and methods An independent systematic review of four scientific databases (PubMed, Scopus, clinicaltrials.gov, Web of Science) was performed to identify relevant articles as per the preferred reporting in systematic reviews and meta-analysis (PRISMA) guidelines. Studies reporting on DVT/PE outcomes of lumbar fusion surgery in adult patients with UH or LMWH chemoprophylaxis were included for analysis. Analysis was performed using the Stata software. Results Twelve studies with 8495 patients were included in the analysis. A single-arm meta-analysis of the included studies found a DVT incidence of 14% (95%CI [8%-20%]) and 1% (95%CI [-6% - 8%]) with LMWH and UH respectively. Both the chemoprophylaxis agents prevented PE with a noted incidence of 0% (95%CI [0%-0.1%]) and 0% (95%CI [0%-1%]) with LMWH and UH respectively. The risk of bleeding-related complications with the usage of LMWH and UH was 0% (95% CI [0.0%-0.30%]) and 3% (95% CI [0.3%-5%]) respectively. Discussion and conclusion Both LMWH and UH reduces the overall incidence of DVT/PE, but there is a paucity of evidence analyzing the comparative effectiveness of the chemoprophylaxis regimens in lumbar fusion procedures. The heterogeneity in data prevents any conclusions, as there remains an evidence gap. We recommend future high-quality randomized controlled trials to investigate in this regard to help develop recommendations on thromboprophylaxis usage.
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Affiliation(s)
- Sathish Muthu
- Department of Spine Surgery, Orthopaedic Research Group, Coimbatore, Tamil Nadu, India
- Department of Biotechnology, Faculty of Engineering, Karpagam Academy of Higher Education, Coimbatore, Tamil Nadu, India
- Department of Orthopaedics, Government Medical College, Karur, Tamil Nadu, India
| | - Georgios Mavrovounis
- Department of Neurosurgery, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Stipe Corluka
- Spinal surgery Division, Department of Traumatology, University Hospital Centre Sestre milosrdnice, Zagreb, Croatia
- Department of Anatomy and Physiology, University of Applied Health Sciences, Zagreb, Croatia
- St. Catherine Specialty Hospital, Zagreb, Croatia
| | - Zorica Buser
- Gerling Institute, Brooklyn, NY, USA
- Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, USA
| | | | - Yabin Wu
- Research Department, AO Spine International, Davos, Switzerland
| | | | - Jeffrey Wang
- Department of Orthopaedic Surgery and Neurological Surgery, Keck School of Medicine, University of Southern California, CA, USA
| | - S. Tim Yoon
- Department of Orthopaedics, Emory University, Atlanta, GA, USA
| | - Andreas K. Demetriades
- Edinburgh Spinal Surgery Outcome Studies Group, Department of Neurosurgery, Royal Infirmary Edinburgh, UK
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An J, Zhang J, Yu T, Wu J, Nie X, He T, Yun Z, Liu R, Xue W, Qi L, Li Y, Liu Q. A Retrospective Comparative Study of Modified Percutaneous Endoscopic Transforaminal Discectomy and Open Lumbar Discectomy for Gluteal Pain Caused by Lumbar Disc Herniation. Front Surg 2022; 9:930036. [PMID: 35813040 PMCID: PMC9257256 DOI: 10.3389/fsurg.2022.930036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/01/2022] [Indexed: 12/29/2022] Open
Abstract
IntroductionThis study aimed to demonstrate the safety and effectiveness of modified percutaneous endoscopic transforaminal discectomy (PETD) in the surgical management of single-segment lumbar disc herniation (LDH) gluteal pain and to determine whether it provides a better clinical outcome than open lumbar discectomy (OD).MethodsA retrospective analysis of patients treated with modified PETD and OD for gluteal pain in LDH from January 2015 to December 2020 was conducted. Sample size was determined using a priori power analysis. Demographic information, surgical outcomes including procedure time (minutes), intraoperative blood loss (mL), hospital days, costs (RMB), fluoroscopy shots, recurrence and complications, etc., were recorded and analyzed. Prognostic outcomes were assessed using the visual analog scale (VAS), the Oswestry Disability Index (ODI), the Japanese Orthopedic Association Score (JOA) and modified MacNab criteria. The preoperative and postoperative VAS, ODI and JOA scores were recorded by two assistants. When the results were inconsistent, the scores were recorded again by the lead professor until all scores were consistently recorded in the data. MRI was used to assess radiological improvement and all patients received follow-ups for at least one year.ResultsThe sample size required for the study was calculated by a priori analysis, and a total of 72 participants were required for the study to achieve 95% statistical test power. A total of 93 patients were included, 47 of whom underwent modified PETD, and 46 of whom underwent OD. In the modified PETD intragroup comparison, VAS scores ranged from 7.14 ± 0.89 preoperatively to 2.00 ± 0.58, 2.68 ± 0.70, 2.55 ± 0.69, 2.23 ± 0.81, and 1.85 ± 0.72 at 7 days, 1 month, 3 months, 6 months, and 12 months postoperatively. Patients showed significant pain relief postoperatively (P < 0.01). According to the modified MacNab score, the excellent rate in the PETD group was 89.36%. There was no significant difference compared to the OD group (89.13%, P > 0.05). Complication rates were lower (P > 0.05) but recurrence rates were higher (P > 0.05) in the modified PETD group than in the OD group. The modified PETD group had a faster operative time (P < 0.01), shorter hospital stay (P < 0.01), less intraoperative bleeding (P < 0.01), and less financial burden to the patient (P < 0.01) than the OD group. At 7 days postoperatively, the VAS score for low back pain was higher in the OD group than in the modified PETD group (P < 0.01). The VAS and JOA scores at 1, 3, 6, and 12 months postoperatively were not significantly different between the modified PETD and OD groups (P > 0.05), and the ODI was significantly different at 3 months postoperatively (P < 0.05).ConclusionModified PETD treatment is safe and effective for gluteal pain due to L4/5 disc herniation and has the advantages of a lower complication rate, faster postoperative recovery, shorter length of stay, fewer anesthesia risks and lower cost of the procedure compared with OD. However, modified PETD has a higher recurrence rate.
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Affiliation(s)
- Junyan An
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Jun Zhang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Tong Yu
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Jiuping Wu
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Xinyu Nie
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Tao He
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Zhihe Yun
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Rui Liu
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Wu Xue
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Le Qi
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Yingzhi Li
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
- Correspondence: Qinyi Liu Yingzhi Li
| | - Qinyi Liu
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
- Correspondence: Qinyi Liu Yingzhi Li
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Zhang Y, Chen J, Xie H, Li K, Wang Y, Chen Q, Jiang C, He J, Fu N. Comparison of the application value of two commonly used minimally invasive spinal surgery in the treatment of lumbar disc herniation. Exp Ther Med 2021; 21:299. [PMID: 33717242 DOI: 10.3892/etm.2021.9730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 11/25/2020] [Indexed: 11/05/2022] Open
Abstract
The aim of the study was to compare the application value of percutaneous transforaminal endoscopic discectomy (PTED) and microendoscopic discectomy (MED) in the treatment of lumbar disc herniation (LDH). From January 2017 to July 2018, 108 LDH patients undergoing surgical treatment in our hospital were collected and divided into PTED group (treated with PTED, n=50) and MED group (treated with MED, n=58). The operation parameter index level, complications, recurrence and pain score (VAS), Oswestry disability index (ODI) and Japanese Orthopaedic Association Scale (JOA) were compared between the two groups. VAS, ODI and JOA scores of the two groups were significantly decreased after operation (P<0.05), but there was no significant difference between the two groups (P>0.05). Complications and recurrence of the two groups were similar (P>0.05). MED was superior to PTED in the number of intraoperative fluoroscopy and operation time, while PTED was superior to MED in intraoperative blood loss, incision length, length of hospital stay and bed rest time (P<0.05). Both PTED and MED can effectively treat LDH. Referring to clinical data, PTED may be the first choice for LDH treatment.
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Affiliation(s)
- Yingbo Zhang
- Department of Orthopaedics, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Jinping Chen
- Department of Orthopaedics, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Haiyang Xie
- Department of Orthopaedics, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Kui Li
- Department of Orthopaedics, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Ye Wang
- Department of Orthopaedics, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Qian Chen
- Department of Orthopaedics, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Cheng Jiang
- Department of Orthopaedics, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Jiangtao He
- Department of Orthopaedics, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Nenggao Fu
- Department of Orthopaedics, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
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