10 SPINELINE | MARCH · APRIL 2017 WWW.SPINELINE-DIGITAL.ORG
Chad M. Craig, MD, FACP
Medical Director, Spine Service
Hospital for Special Surgery
New York, NY, USA
Inferior Vena Cava Filters
and Spine Surgery
The use of inferior vena cava (IVC) filters surrounding spine surgery requires a careful
balance of the potential benefits and risks of the filter devices, as they apply to select
patient and surgical risk profiles. Such filters have the potential to prevent both fatal and
nonfatal pulmonary emboli (PE). However, an understanding of the underlying risks and
benefits of filters is essential to make informed decisions with patients. Here we review
the literature surrounding the use of IVC filters in patients undergoing spine surgery,
and draw on data from other surgical cohorts as needed, with special attention paid to
highlighting potential risks of IVC filters.
IVC filters have the potential to protect patients from life-threatening PE.
1 However, in
our experience, the potential risks and benefits of filters are often not well understood
by clinicians caring for patients undergoing spinal surgery, resulting in inappropriate
use or potential failure to consider a strong indication for a filter. Here we review the
existing literature on this topic as it applies to the special considerations surrounding
spinal surgery to assist clinicians in carrying out more informed decisions with patients.
Where data are not available specific to spine surgery, we have drawn on the more commonly studied groups of trauma and bariatric surgery. Filters may be placed for primary
prevention, also known as prophylactic placement, which is defined here as placement
before any deep venous thrombosis (DVT) or PE has occurred. Alternatively, they may
be placed for secondary prevention, used with the goal of preventing known or additional
DV T burden from reaching the lungs.
Venous thromboembolism (V TE) refers to the collective grouping of deep venous thrombosis and PE events. The incidence of V TE following spine surgery was recently reviewed
2 and varies with patient risk factors, type of surgery, length of surgery,
modalities of VTE prevention and screening tools used. A wide range of VTE incidences
have been reported in the literature, ranging between 0.29%– 31.0%.
3-6 Reported rates of
symptomatic VTE events in spine surgery patients considered broadly, who are not receiving pharmacologic prophylaxis, are generally < 2%.
7, 8 Whereas, in some of the most
consistent estimates arising from prospective studies utilizing universal screening for
DV T and PE, and likewise where patients did not receive pharmacologic V TE prophylaxis,
VTE rates are consistently reported around 8%, with the majority of these being DVT
9,10 Smaller cohort studies of spine surgery examining universal lower extremity
duplex ultrasound and contrast-enhanced CT of the chest have, however, identified rates
as high at 25% for DVT and 18% for PE, respectively.
Studies of IVC filter placements in general, not specific to spine surgery, have demonstrated
that IVC filters have been increasingly utilized in recent decades,
13 and a significant portion
In a recent survey
of spine surgeons, 77%
of surgeons who use IVC
filters insert them before
surgery, with the remainder
preferring to insert them
either intraoperatively or