A Protocol for Venous Thromboembolism Prophylaxis in Elective Spine Surgery: A Retrospective Evaluation of a Single-Center Experience

Hani Aljohani; Abdulrahman H Alashkar; Ghada K Alkafarnah; Monirh M Almeshigeh; Abdullh A Alsadoon; Amr Alfakhouri

doi:10.7759/cureus.85297

A Protocol for Venous Thromboembolism Prophylaxis in Elective Spine Surgery: A Retrospective Evaluation of a Single-Center Experience

Cureus. 2025 Jun 3;17(6):e85297. doi: 10.7759/cureus.85297. eCollection 2025 Jun.

Authors

Hani Aljohani^{1

2}, Abdulrahman H Alashkar², Ghada K Alkafarnah², Monirh M Almeshigeh¹, Abdullh A Alsadoon¹, Amr Alfakhouri³

Affiliations

¹ College of Medicine, Qassim University, Buraidah, SAU.
² Department of Surgery, Dr. Sulaiman Al-Habib Medical Group, Buraidah, SAU.
³ Department of Medicine, Dr. Sulaiman Al-Habib Medical Group, Buraidah, SAU.

Abstract

Introduction: Venous thromboembolic (VTE) events include deep vein thrombosis (DVT) and pulmonary embolism (PE). In spine surgery, the risk of VTE events should be weighed against the risk of developing epidural hematoma (EDH). This has made the subject of VTE prophylaxis in spine surgery an ongoing matter of debate in the scientific community.

Objective: To present our experience with venous thromboembolism prophylaxis in patients undergoing elective spine surgery and discuss it in the light of the literature.

Methods: This was a retrospective review done on all patients who underwent elective spine surgery at our institution from 2019 to 2024 and were prescribed a specified VTE prophylaxis protocol (inpatient enoxaparin and a seven-day course of rivaroxaban following discharge). Patients who underwent spine surgery for non-elective indications, were known to have a malignancy, had a history of VTE, were already on anticoagulant therapy, and/or were non-ambulatory, were excluded.

Results: A total of 528 patients were included; 284 (53.78%) patients were males, and 354 (67.04%) surgeries were thoraco-lumbar. Of the 174 (32.95%) surgeries performed on the cervical spine, 105 were anterior discectomies and 69 were laminectomies. The mean age (±SD) was 55.06 years (±14.9). The majority of the included patients were overweight/obese; 447 patients (84.65%). Of all the patients, 452 (85.6%) started to ambulate on Day 1, and the mean (±SD) length of hospital stay was comparable for patients undergoing cervical and thoracolumbar spine surgeries, 4.6 (±1.3) and 4.8 (±1.6), respectively. None of the patients experienced VTE events, while three (0.56%) developed EDH.

Conclusion: The protocol presented in this report is safe and effective in preventing VTE in ambulatory patients undergoing elective spine surgery. Rivaroxaban is a possible option for VTE prophylaxis in patients undergoing elective spine surgery, including procedures involving the cervical spine.

Keywords: cervical spine; prophylaxis; rivaroxaban.; spine surgery; venous thromboembolism.