Abstract
Introduction: In spine and spinal cord surgery with the potential risk of major bleeding and subsequent epidural hematoma, it has been common practice to discontinue ongoing antithrombotic therapy during the perioperative period. However, the cessation of anticoagulant and/or antiplatelet agents can increase underlying thrombosis risk such as acute cerebrovascular and cardiovascular events, which may result in catastrophic consequences. Minimally invasive spine surgery (MISS) may provide a breakthrough for decision-making by the risk-benefit analysis. Accumulated evidence revealed indirect neural decompression after lateral lumbar interbody fusion (LLIF), which, thereby, can minimize bleeding risk as a result of obviating the need for easily bleeding direct neural decompression. The current study compared perioperative complications of LLIF procedure combined with percutaneous pedicle screw fixation (PPS) between patients who continued and discontinued taking antithrombotic agents during the perioperative period.
Methods: This retrospective study included 33 patients (mean age, 74.4 years) who underwent lumbar MISS with LLIF and PPS fixation. The patients were divided into two groups depending on whether they should have continued to take ongoing antithrombotic agents (continuation group [17 patients]) or they could discontinue having them (discontinuation group [16 patients]) during the perioperative period. Prior to the operation, 3 parties consisting of orthopedic surgeons, anesthesiologists, and physicians in charge of the patients' antithrombotic therapy jointly determined for each patient either of the two different types of strategies to optimize individualized treatment and care.
Results: The two groups showed no statistically significant difference in age and number of levels fused. Intraoperative blood loss tended to be larger in the continuation than in the discontinuation group, although the difference did not reach statistical significance. In contrast, the continuation group showed significantly larger postoperative blood loss than the discontinuation group (p=0.0241). The decrease rates of hemoglobin and hematocrit levels tended to be higher in the continuation than the discontinuation group both on the postoperative Day 1 and 7, although not statistically significant. Three patients in the continuation group (17.6%) and none of the patients in the discontinuation group (p=0.0390) needed a blood transfusion. No perioperative morbidities including spinal bleeding-related complications and thrombotic complications occurred in either group.
Conclusions: The results of the current study suggest that the MISS (LLIF+PPS) could allow the use of anticoagulant and antiplatelet to be safely continued perioperatively in the patients with high-risk of thromboembolic events.
