We have never used antithrombotic prophylaxis in surgery of scoliosis in children or young and have not had any problems in the postoperative

I do not. I have not experienced any complications.

Also we have never used antithrombotic prophylaxis in this kind of surgery, and haven't had until now any problems postoperatively. But this is question for discussion. 

Good question dear Panayot. As we all know, scoliosis surgery is a long last procedure and it a surgery that could carry out serious complications. Despite unknowing the real value of thrombosis in this age related to the time of the surgery, considering the data of general thrombosis, the post-op I think is the key with an early movilization as soon as posible. In sum, I would not consider using antithrombotic prophylaxis in those cases. 

Thank you, dear colleagues, for your answers. I never use pharmacological antithrombotic prophylaxis for scoliosis surgery.

In more than 2000 cases (42 years) I have observed only one case with DVT some 20 years ago. It was an obese girl of 16 years of age with a severe and rigid thoracolumbar curve. Probably, another fact was important to explain this complication. She spent 2 weeks on halo-femoral traction and then she was subjected to instrumented scoliosis surgery. The early mobilization was impossible. However, she was successfully treated with high doses of fractionated heparin using perfusor. She recovered well.  

only adolescent patients with risk factors (obesity, oral contraception, long term central lines etc.)

Dear Enrique,

Your answer is a good option.

i agree with all thats beeen said. i use mechanical ie foot pumps and mobilize the day of surgery or post op day one

We do not use. One of the reasons is the risk of hemorrhagic tendency. We have not experienced thrombotic in scoliosis surgery for children and adolescents.

Thank you, Dr. He. I share your opinion.

We don't use prophylactic antithrombotic drugs in scoliosis in children or even adolescents during our experience period (last 11 years). We didn't see any case of DVT in our patients who was operated for scoliosis or kyphosis.  

Dear Panayot

I dont use

Only in patients with risk factors

Have not experienced a single case of PE or clinically obvious DVT in 35 years of scoliosis surgery with over one hundred cases a year, with quite a few cases aged late in the second decade, and with high BMI!

so no prophylaxis apart from TED hose placed immediately before surgery and kept on for 2 days post op.

Thank you, Dr. King. I share you opinion and clinical experience . The reason  to  ask this question  is  that  in  some standards for practicing orthopaedic surgery /i.e  . in my country/ the  requirement for pharmacolgic antithrombotic prophylaxis is imperatively required for major surgeries. No differentiation according to age, kind of operation,etc. is made. This  could  lead to litigation procedures in case of   rare PE or DVT after scoliosis .   Nevertheless, I do not use  anticoagulants for scoliosis surgery in adolescents.

Yes,I start Cephlexin or Vancomycin 12 hours before surgery and continue for 24 hours post-operatively.

Dear Dr. Rahimizadeh,

We are discussing antithrombotic prophylaxis and not antibiotic !

We, in more than 5.000 patents ,since 1986 , have never used antithrombotic drugs , and we have not a case of problem

No I don't use antithrombotic prophylaxis in the 14 years of scoliosis surgery and have not been faced with any case of DVT or PE. I also keep the TED no more than 2 days given that these children start with mobilisation on the second to 3rd day.

Regards

Mac

In more than 100 cases per year,since 1979,we did not use routinely antithrombotic pophilaxis at all.We reported one only case of DVT (cava inferior ) treated by means of   heparin therapy without consequences.

I think that  during procedure ( pedicular tapping,screw passing ) We have to take in account unavoidable micro pulmonary embolism.It is well detectable by means of transoesophageal sonograms.

In my opinion , patients with patent foramen ovale need to be protected with antithrombotic prophilaxis.

No indication for high BMI

Regards

Guido

Dear Guido,

I share entirely your opinion.

Guido,

I am interested in the idea of micro embolism during pedicle screw tapping and passage . Do you have any data on that?

Dear Andrew,

I have some experience with the perioperative transoesophageal echocardiography (PTE) for cementless or cemented hip arthroplasty. Especially, in case of cemented endoprosthesis there is an avalanche of signals to be detected by the PTE which is explained with the monomers of the bone cement during the process of polymerization. On the other hand, the incidence of clinically manifested PE is relatively rare.

There are some reports for PE (even fatal) in case of vertebroplasty for osteoporotic vertebral fractures.

I do not use PTE during scoliosis surgery for adolescents and I do not believe there is a lot of literature data on practicing PTE during placing pedicle screws for scoliosis. 

 Dear all.

A recent published paper reported a very low incidence  of PE in idiopathic scoliosis( a mean of 2 cases per 10.000) with an higher prevalence in case of congenital or syndromic aethology.

Micro pulmonary embolism during the insertion of pedicle screws is reported by Takahashi et al.

I think the problem is slightly underestimated, due to low or absent clinical impact on patients,anyway it exists.

I do not use PTE during scoliosis surgery.

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J Bone Joint Surg Br. 2003 Jan;85(1):90-4.

Intraoperative pulmonary embolism during spinal instrumentation surgery. A prospective study using transoesophageal echocardiography.

Takahashi S1, Kitagawa H, Ishii T.

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Spine (Phila Pa 1976). 2014 Jul 15;39(16):1325-9. doi: 10.1097/BRS.0000000000000402.

Thromboembolic complications in children after spinal fusion surgery.

Jain A1, Karas DJ, Skolasky RL, Sponseller PD.

Thank you, Guido, for the references.

I believe the problem of PE and DVT is more serious when doing vertebroplasty. In the case of kyphoplasty these complications are rarer because of the preliminary preparation of room for the cement and the lower intravertebral pressure.  

Dear Panayot,

I agree with you about vertebro-kyphoplasty,

But in  cases of AIS we need to take in account a low risk of DVT and even of PE and this issue need to be well described in informed consent.

Dear Guido,

I agree entirely with you.

Dear Sir i am recently working with scoliosis surgery and unfortunatly in the last 10 months i had two pulmonary embolisms in total of 15 patients and i would be very greatfull to discuss. Eleni Koraki

Elena,what were the ages of your patients who had PEs?

Elena, how did you confirm the diagnosis of PE ? Did the patients receive some sort of perioperative antithrombotic prophylaxis ?