Although several studies of carefully selected spine surgery
patients suggest potential benefit from IVC filter placement,
complication rates of IVC filters are not insignificant in our
review of the literature. In patients planning spine surgery
identified as high risk for VTE, a careful consideration of
the potential benefits and risks of primary prevention IVC
filter placement is warranted. We propose that patients
being considered for primary prophylactic IVC filter placement generally have at least one of the following risk factors:
morbid obesity, history of VTE, active malignancy, known
thrombophilia, combined anterior/posterior approach,
iliocaval manipulation, surgery > 6 hours or operations
consisting of multiple levels. Based on current professional
society guidelines, a stronger case can be made for IVC filter
placement for secondary prevention more so than primary
prevention, although again, even with secondary prevention
it is important that anticoagulation is considered first and
deemed contraindicated. Temporary filters appear to have
higher complication rates than permanent filters, thus close
follow-up and appropriate retrieval programs are encouraged
in those patients in whom they are placed.
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