{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T06:30:11Z","timestamp":1787725811077,"version":"build-2784847793"},"reference-count":60,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Perioperative management of antithrombotic therapy in degenerative spine surgery remains a challenging clinical issue, particularly in elderly patients with cardiovascular comorbidities requiring chronic anticoagulant or antiplatelet treatment. Although several guidelines address perioperative anticoagulation in high\u2013bleeding-risk procedures, procedure-specific evidence in elective spinal surgery remains limited, and clinical practice is still heterogeneous.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A multicenter retrospective cohort study was conducted including 767 consecutive patients aged 60\u202fyears or older who underwent elective surgery for degenerative spine disease. Surgical procedures included anterior cervical discectomy and fusion, lumbar microdiscectomy for disc herniation, decompression for lumbar spinal stenosis, and monosegmental posterior lumbar interbody fusion. Patients were stratified according to perioperative antithrombotic management into three groups: no chronic antithrombotic therapy, perioperative low-molecular-weight heparin substitution, and temporary perioperative substitution with low-dose aspirin. Intraoperative hemoglobin loss, operative time, postoperative length of stay, and perioperative complications were compared across groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Perioperative outcomes were similar among the three antithrombotic management groups across all procedures. Intraoperative hemoglobin loss, operative duration, and postoperative hospitalization showed no significant differences between patients undergoing low-molecular-weight heparin substitution or aspirin continuation and those without chronic antithrombotic therapy. No cases of postoperative spinal epidural hematoma requiring evacuation, myocardial infarction, stroke, deep venous thrombosis, or pulmonary embolism were observed. The observed between-group differences in hemoglobin loss, operative time, and postoperative hospitalization remained within the predefined clinically meaningful margins.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this multicenter cohort of 767 consecutive patients undergoing common degenerative spine procedures, perioperative antithrombotic management based on low-molecular-weight heparin substitution or low-dose aspirin substitution was not associated with clinically relevant worsening of perioperative outcomes when compared with patients not receiving chronic antithrombotic therapy. These findings suggest that structured perioperative antithrombotic protocols may represent a reasonable strategy in elective degenerative spine surgery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1831400","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T06:04:34Z","timestamp":1787724274000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Perioperative antithrombotic management in degenerative spine surgery: a multicenter cohort of 767 consecutive patients"],"prefix":"10.3389","volume":"13","author":[{"given":"Giuseppe","family":"Corazzelli","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Santa Maria delle Grazie Hospital, ASL Napoli 2 Nord","place":["Pozzuoli, Italy"]},{"name":"Department of Human Neurosciences, Sapienza University of Rome","place":["Rome, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergio","family":"Corvino","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Presidio Ospedaliero \u201cOspedale del Mare\u201d","place":["Naples, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide De Los","family":"Rios","sequence":"additional","affiliation":[{"name":"University of Naples Federico II","place":["Naples, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diego","family":"Gentile","sequence":"additional","affiliation":[{"name":"Department of Women, Child, General and Specialistic Surgery, University of Campania \u201cL. Vanvitelli\u201d","place":["Naples, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Di Domenico","sequence":"additional","affiliation":[{"name":"Department of Neurosciences and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, University of Naples Federico II","place":["Naples, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Corazzelli","sequence":"additional","affiliation":[{"name":"Department of Advanced Medical and Surgical Sciences, University of Campania \u201cLuigi Vanvitelli\u201d","place":["Naples, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gennaro","family":"De Rosa","sequence":"additional","affiliation":[{"name":"Department of Translational Medical Sciences, University of Naples Federico II","place":["Naples, Italy"]},{"name":"Department of Advanced Biomedical Sciences, Universit\u00e0 degli Studi di Napoli \u201cFederico II\u201d","place":["Napoli, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Fiore","sequence":"additional","affiliation":[{"name":"Department of Translational Medical Sciences, University of Naples Federico II","place":["Naples, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristiana","family":"Germano","sequence":"additional","affiliation":[{"name":"Department of Maxillofacial Surgery, Azienda Ospedaliera \u201cSan Pio\u201d","place":["Benevento, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Filippelli","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine and Surgery, University of Naples Federico II","place":["Naples, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niccol\u00f2","family":"Colella","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, IRCCS Neuromed","place":["Pozzilli, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Ricciardi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, IRCCS Neuromed","place":["Pozzilli, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"D\u2019Elia","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, IRCCS Neuromed","place":["Pozzilli, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Settimio","family":"Leonetti","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, IRCCS Neuromed","place":["Pozzilli, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Sacco","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Intensive Care Medicine, Santa Maria delle Grazie Hospital, ASL Napoli 2 Nord","place":["Pozzuoli, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenzo","family":"Meglio","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Azienda Ospedaliera di Rilievo Nazionale \u201cSant\u2019Anna e San Sebastiano\u201d","place":["Caserta, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Pizzuti","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, IRCCS Neuromed","place":["Pozzilli, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Di Russo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, IRCCS Neuromed","place":["Pozzilli, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Gorgoglione","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, IRCCS Neuromed","place":["Pozzilli, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giandomenico","family":"Petrella","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, IRCCS Neuromed","place":["Pozzilli, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ciro","family":"Mastantuoni","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Santa Maria delle Grazie Hospital, ASL Napoli 2 Nord","place":["Pozzuoli, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Rosaria","family":"Scala","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Santa Maria delle Grazie Hospital, ASL Napoli 2 Nord","place":["Pozzuoli, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelangelo","family":"de Angelis","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, IRCCS Neuromed","place":["Pozzilli, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"De Bellis","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Azienda Ospedaliera di Rilievo Nazionale \u201cSant\u2019Anna e San Sebastiano\u201d","place":["Caserta, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Cioffi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Santa Maria delle Grazie Hospital, ASL Napoli 2 Nord","place":["Pozzuoli, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fulvio","family":"Aloj","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, IRCCS Neuromed","place":["Pozzilli, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luigi","family":"Sigona","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Santa Maria delle Grazie Hospital, ASL Napoli 2 Nord","place":["Pozzuoli, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Bocchetti","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Santa Maria delle Grazie Hospital, ASL Napoli 2 Nord","place":["Pozzuoli, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvatore","family":"Di Colandrea","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Intensive Care Medicine, Santa Maria delle Grazie Hospital, ASL Napoli 2 Nord","place":["Pozzuoli, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Coscia","sequence":"additional","affiliation":[{"name":"Department of Maxillofacial Surgery, Azienda Ospedaliera \u201cSan Pio\u201d","place":["Benevento, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Beatrice","family":"Passavanti","sequence":"additional","affiliation":[{"name":"Department of Women, Child, General and Specialistic Surgery, University of Campania \u201cL. Vanvitelli\u201d","place":["Naples, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra","family":"Cuomo","sequence":"additional","affiliation":[{"name":"Department of Translational Medical Sciences, University of Naples Federico II","place":["Naples, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pasqualino","family":"De Marinis","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Azienda Ospedaliera di Rilievo Nazionale \u201cSant\u2019Anna e San Sebastiano\u201d","place":["Caserta, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo Gabriele","family":"Tocchetti","sequence":"additional","affiliation":[{"name":"Department of Translational Medical Sciences, University of Naples Federico II","place":["Naples, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oreste","family":"de Divitiis","sequence":"additional","affiliation":[{"name":"Department of Neurosciences and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, University of Naples Federico II","place":["Naples, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauro","family":"Mormile","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine and Surgery, University of Naples Federico II","place":["Naples, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Plinio","family":"Cirillo","sequence":"additional","affiliation":[{"name":"Department of Translational Medical Sciences, University of Naples Federico II","place":["Naples, Italy"]},{"name":"Department of Advanced Biomedical Sciences, Universit\u00e0 degli Studi di Napoli \u201cFederico II\u201d","place":["Napoli, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Catapano","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Presidio Ospedaliero \u201cOspedale del Mare\u201d","place":["Naples, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raffaele","family":"de Falco","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Santa Maria delle Grazie Hospital, ASL Napoli 2 Nord","place":["Pozzuoli, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergio","family":"Paolini","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, IRCCS Neuromed","place":["Pozzilli, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenzo","family":"Esposito","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, IRCCS Neuromed","place":["Pozzilli, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gualtiero","family":"Innocenzi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, IRCCS Neuromed","place":["Pozzilli, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,26]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1322","DOI":"10.1227\/neu.0000000000003494","article-title":"Management of anticoagulant and antiplatelet therapy in elective degenerative lumbosacral spine surgery: a clinical study on 578 elderly patients","volume":"97","author":"Corazzelli","year":"2022","journal-title":"Neurosurgery"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"784","DOI":"10.1177\/2192568218770769","article-title":"Degenerative lumbar spine disease: estimating global incidence and worldwide volume","volume":"8","author":"Ravindra","year":"2018","journal-title":"Global Spine J"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"2415","DOI":"10.1160\/TH17-08-0553","article-title":"The perioperative anticoagulant use for surgery evaluation (PAUSE) study for patients on a direct oral anticoagulant who need an elective surgery or procedure: design and rationale","volume":"117","author":"Douketis","year":"2017","journal-title":"Thromb Haemost"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"100","DOI":"10.25259\/SNI-191-2019","article-title":"A review of complication rates for anterior cervical diskectomy and fusion (ACDF)","volume":"10","author":"Epstein","year":"2019","journal-title":"Surg Neurol Int"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1046","DOI":"10.1016\/j.spinee.2009.09.005","article-title":"An evidence-based clinical guideline for the use of antithrombotic therapies in spine surgery","volume":"9","author":"Bono","year":"2009","journal-title":"Spine J"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1097\/AAP.0000000000000763","article-title":"Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine evidence-based guidelines","volume":"39","author":"Horlocker","year":"2019","journal-title":"Obstet Anesth Dig"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1097\/AAP.0000000000000700","article-title":"Interventional spine and pain procedures in patients on antiplatelet and anticoagulant medications: guidelines from the American society of regional anesthesia and pain medicine, the European society of regional anaesthesia and pain therapy, the American Academy of pain medicine, the international neuromodulation society, the north American neuromodulation society, and the world institute of pain","volume":"43","author":"Narouze","year":"2018","journal-title":"Reg Anesth Pain Med"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"512","DOI":"10.1177\/2192568219897598","article-title":"Perioperative anticoagulation management in spine surgery: initial findings from the AO spine anticoagulation global survey","volume":"10","author":"Louie","year":"2020","journal-title":"Glob Spine J"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"408","DOI":"10.1097\/BRS.0000000000005330","article-title":"Perioperative safety of lumbar decompression surgery performed under continuous low-dose aspirin administration","volume":"51","author":"Takaoka","year":"2026","journal-title":"Spine"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1939","DOI":"10.1016\/j.spinee.2017.08.238","article-title":"Risk of aspirin continuation in spinal surgery: a systematic review and meta-analysis","volume":"17","author":"Goes","year":"2017","journal-title":"Spine J"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"e8603","DOI":"10.1097\/MD.0000000000008603","article-title":"Safety of continuing aspirin therapy during spinal surgery: a systematic review and meta-analysis","volume":"96","author":"Zhang","year":"2017","journal-title":"Medicine"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"195","DOI":"10.22603\/ssrr.2024-0168","article-title":"Safety of continuous low-dose aspirin therapy for lumbar decompression alone","volume":"9","author":"Inoue","year":"2025","journal-title":"Spine Surg Relat Res"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1","DOI":"10.4103\/jmedsci.jmedsci_87_24","article-title":"The influence of preoperative antiplatelet and anticoagulant agents on outcomes in patients undergoing anterior cervical discectomy","volume":"45","author":"Kao","year":"2025","journal-title":"J Med Sci"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"ii74","DOI":"10.1093\/bja\/aew214","article-title":"New antiplatelet drugs and new oral anticoagulants","volume":"117","author":"Koenig-Oberhuber","year":"2016","journal-title":"Br J Anaesth"},{"key":"ref15","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-319-27327-3","volume-title":"Anticoagulation and Hemostasis in Neurosurgery","author":"Loftus","year":"2016"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"100295","DOI":"10.1016\/j.xnsj.2023.100295","article-title":"Chemical prophylaxis and venous thromboembolism following elective spinal surgery: a systematic review and meta-analysis","volume":"17","author":"Rahmani","year":"2024","journal-title":"North Am Spine Soc J"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1093\/ons\/opaa265","article-title":"The Smith-Robinson approach to the subaxial cervical spine: a stepwise microsurgical technique using volumetric models from anatomic dissections","volume":"20","author":"Vigo","year":"2021","journal-title":"Operat Neurosurg"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"645","DOI":"10.1016\/j.amjmed.2023.03.024","article-title":"Lumbar disc herniation: diagnosis and management","volume":"136","author":"Zhang","year":"2023","journal-title":"Am J Med"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"818","DOI":"10.1056\/NEJMcp0708097","article-title":"Clinical practice. Lumbar spinal stenosis","volume":"358","author":"Katz","year":"2008","journal-title":"N Engl J Med"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"h6234","DOI":"10.1136\/bmj.h6234","article-title":"Management of lumbar spinal stenosis","volume":"352","author":"Lurie","year":"2016","journal-title":"BMJ"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1087","DOI":"10.1007\/s00586-009-1274-4","article-title":"MSU classification for herniated lumbar discs on MRI: toward developing objective criteria for surgical selection","volume":"19","author":"Mysliwiec","year":"2010","journal-title":"Eur Spine J"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"2","DOI":"10.3978\/j.issn.2414-469X.2015.10.05","article-title":"Lumbar interbody fusion: techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF\/ATP, LLIF and ALIF","volume":"1","author":"Mobbs","year":"2015","journal-title":"J Spine Surg"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1155","DOI":"10.1007\/s00402-019-03282-9","article-title":"Lumbar spinal fusion of low-grade degenerative spondylolisthesis (Meyerding grade I and II): Do reduction and correction of the radiological sagittal parameters correlate with better clinical outcome?","volume":"140","author":"Oikonomidis","year":"2020","journal-title":"Arch Orthop Trauma Surg"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"2016","DOI":"10.1016\/j.spinee.2015.05.010","article-title":"Pseudoarthrosis rates in anterior cervical discectomy and fusion: a meta-analysis","volume":"15","author":"Shriver","year":"2015","journal-title":"Spine J"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"3076","DOI":"10.3390\/jcm10143076","article-title":"Clinical outcomes between stand-alone zero-profile spacers and cervical plate with cage fixation for anterior cervical discectomy and fusion: a retrospective analysis of 166 patients","volume":"10","author":"Sommaruga","year":"2021","journal-title":"J Clin Med"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"1919","DOI":"10.1097\/BRS.0b013e3181d359bd","article-title":"Qualitative grading of severity of lumbar spinal stenosis based on the morphology of the dural sac on magnetic resonance images","volume":"35","author":"Schizas","year":"2010","journal-title":"Spine"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"732","DOI":"10.1007\/s00586-015-3864-7","article-title":"Non-instrumented extradural lumbar spine surgery under low-dose acetylsalicylic acid: a comparative risk analysis study","volume":"25","author":"Soleman","year":"2016","journal-title":"Eur Spine J"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"446","DOI":"10.1177\/2192568218774576","article-title":"Comparison of anterior cervical discectomy and fusion with a stand-alone interbody cage versus a conventional cage-plate technique: a systematic review and meta-analysis","volume":"9","author":"Cheung","year":"2019","journal-title":"Global Spine J"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"13","DOI":"10.14245\/kjs.2016.13.1.13","article-title":"Stand-alone cages for anterior cervical fusion: Are there no problems?","volume":"13","author":"Han","year":"2016","journal-title":"Korean J Spine"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"192","DOI":"10.4103\/jcvjs.jcvjs_146_21","article-title":"Spinal cervical extradural hemangioblastoma","volume":"13","author":"Mariniello","year":"2022","journal-title":"J Craniovert Junct Spine"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"1199","DOI":"10.1111\/trf.16889","article-title":"Is routine blood typing and screening necessary for degenerative cervical spine surgery patients in specialty surgical hospitals?","volume":"62","author":"N\u00fa\u00f1ez","year":"2022","journal-title":"Transfusion"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"807","DOI":"10.1007\/s10143-024-03059-8","article-title":"Perioperative management of antithrombotic therapy in elderly patients undergoing lumbar discectomy: a retrospective study on 163 patients","volume":"47","author":"Corazzelli","year":"2024","journal-title":"Neurosurg Rev"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"E20","DOI":"10.3171\/FOC\/2008\/25\/8\/E20","article-title":"Perioperative results following lumbar discectomy: comparison of minimally invasive discectomy and standard microdiscectomy","volume":"25","author":"German","year":"2008","journal-title":"Neurosurg Focus"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"3389","DOI":"10.1007\/s00586-025-08985-9","article-title":"Evaluating the predictive value of multimodal intraoperative neuromonitoring in anterior cervical discectomy and fusion: a retrospective cohort study on 442 patients","volume":"34","author":"Corazzelli","year":"2025","journal-title":"Eur Spine J"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1159\/000521288","article-title":"Charlson comorbidity index: a critical review of clinimetric properties","volume":"91","author":"Charlson","year":"2022","journal-title":"Psychother Psychosom"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"2940","DOI":"10.1097\/00007632-200011150-00017","article-title":"The Oswestry disability index","volume":"25","author":"Fairbank","year":"2000","journal-title":"Spine"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1097\/SLA.0b013e3181b13ca2","article-title":"The Clavien-Dindo classification of surgical complications: five-year experience","volume":"250","author":"Clavien","year":"2009","journal-title":"Ann Surg"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3171\/2023.8.SPINE221332","article-title":"Antithrombotic therapy and spinal surgery: a retrospective cohort study of 289 consecutive elderly patients with degenerative lumbar stenosis","volume":"1","author":"Corazzelli","year":"2023","journal-title":"J Neurosurg Spine"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"2594","DOI":"10.1001\/jama.2012.87802","article-title":"Reporting of noninferiority and equivalence randomized trials: extension of the CONSORT 2010 statement","volume":"308","author":"Piaggio","year":"2012","journal-title":"JAMA"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1111\/j.1540-8191.2007.00402.x","article-title":"Does the use of preoperative aspirin increase the risk of bleeding in patients undergoing coronary artery bypass grafting surgery? Systematic review and meta-analysis","volume":"22","author":"Alghamdi","year":"2007","journal-title":"J Card Surg"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"791713","DOI":"10.3389\/fsurg.2021.791713","article-title":"Antithrombotic therapy in spinal surgery does not impact patient safety\u2013a single center cohort study","volume":"8","author":"Banat","year":"2022","journal-title":"Front Surg"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"1469","DOI":"10.1001\/jamainternmed.2019.2431","article-title":"Perioperative management of patients with atrial fibrillation receiving a direct oral anticoagulant","volume":"179","author":"Douketis","year":"2019","journal-title":"JAMA Intern Med"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"693","DOI":"10.1016\/S0735-1097(00)00808-1","article-title":"Randomized trial of low molecular weight heparin (enoxaparin) versus unfractionated heparin for unstable coronary artery disease: one-year results of the ESSENCE study","volume":"36","author":"Goodman","year":"2000","journal-title":"J Am Coll Cardiol"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"1206","DOI":"10.1056\/NEJM198411083111902","article-title":"Dose-related kinetics of aspirin: presystemic acetylation of platelet cyclooxygenase","volume":"311","author":"Pedersen","year":"1984","journal-title":"N Engl J Med"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1097\/BSD.0000000000001260","article-title":"Narrative review of antiplatelet and anticoagulant medications for venous thromboembolism prevention in spine surgery","volume":"35","author":"Louie","year":"2022","journal-title":"Clin Spine Surg"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1007\/BF00257808","article-title":"Prevention of deep vein thrombosis in neurosurgical patients: a prospective double-blind comparison of two prophylactic regimen","volume":"15","author":"Voth","year":"1992","journal-title":"Neurosurg Rev"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"3274","DOI":"10.1007\/s00586-022-07421-6","article-title":"Incidence of postoperative symptomatic spinal epidural hematoma requiring surgical evacuation: a systematic review and meta-analysis","volume":"31","author":"Chen","year":"2022","journal-title":"Eur Spine J"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"324","DOI":"10.1186\/s12891-020-03337-8","article-title":"Incidence and risk factors of spinal epidural hemorrhage after spine surgery: a cross-sectional retrospective analysis of a national database","volume":"21","author":"Park","year":"2020","journal-title":"BMC Musculoskelet Disord"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"1791","DOI":"10.1056\/NEJMoa1500857","article-title":"Long-term use of ticagrelor in patients with prior myocardial infarction","volume":"372","author":"Bonaca","year":"2015","journal-title":"N Engl J Med"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"286","DOI":"10.1007\/s40140-021-00511-z","article-title":"Perioperative guidelines on antiplatelet and anticoagulant agents: 2022 update","volume":"12","author":"Moster","year":"2022","journal-title":"Curr Anesthesiol Rep"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"150","DOI":"10.9738\/CC71.1","article-title":"Deep venous thrombosis in spine surgery patients: incidence and hematoma formation","volume":"97","author":"Al-Dujaili","year":"2012","journal-title":"Int Surg"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"108205","DOI":"10.1016\/j.clineuro.2024.108205","article-title":"Safety and efficacy of apixaban vs. enoxaparin in thromboprophylaxis after spinal stenosis and degenerative spine surgery","volume":"239","author":"Bagheri","year":"2024","journal-title":"Clin Neurol Neurosurg"},{"key":"ref53","doi-asserted-by":"publisher","first-page":"101","DOI":"10.25259\/SNI_139_2023","article-title":"A challenging recurrent thoracic disc herniation","volume":"14","author":"Capece","year":"2023","journal-title":"Surg Neurol Int"},{"key":"ref54","doi-asserted-by":"publisher","first-page":"E174","DOI":"10.1097\/BRS.0000000000004932","article-title":"The Goutallier classification system: How does paravertebral adipose degeneration change in patients with symptomatic lumbar spinal stenosis?","volume":"49","author":"Corazzelli","year":"2024","journal-title":"Spine"},{"key":"ref55","doi-asserted-by":"publisher","first-page":"825","DOI":"10.1001\/jama.2024.12708","article-title":"Perioperative management of patients taking direct oral anticoagulants: a review","volume":"332","author":"Douketis","year":"2024","journal-title":"JAMA"},{"key":"ref56","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1097\/EJA.0000000000001600","article-title":"Regional anaesthesia in patients on antithrombotic drugs: joint ESAIC\/ESRA guidelines","volume":"39","author":"Kietaibl","year":"2022","journal-title":"Euro J Anaesthesiol"},{"key":"ref57","doi-asserted-by":"publisher","first-page":"53S","DOI":"10.1177\/2192568219852051","article-title":"Anticoagulation and spine surgery","volume":"10","author":"GBF","year":"2020","journal-title":"Glob Spine J"},{"key":"ref58","doi-asserted-by":"publisher","first-page":"2010","DOI":"10.1016\/j.spinee.2021.06.011","article-title":"Open epidural blood patch to augment durotomy repair in lumbar spine surgery: surgical technique and cohort study","volume":"21","author":"Xiong","year":"2021","journal-title":"Spine J"},{"key":"ref59","doi-asserted-by":"publisher","first-page":"3065","DOI":"10.1177\/21925682251318266","article-title":"Impact of antiplatelet medication continuation on surgical outcomes after minimally invasive posterior lumbar decompression surgery: retrospective cohort study","volume":"15","author":"Sawada","year":"2025","journal-title":"Global Spine J"},{"key":"ref60","doi-asserted-by":"publisher","first-page":"e1034","DOI":"10.1016\/j.wneu.2019.01.236","article-title":"Direct oral anticoagulants in patients undergoing spine surgery","volume":"125","author":"Croci","year":"2019","journal-title":"World Neurosurg"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1831400\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T06:04:36Z","timestamp":1787724276000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1831400\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,26]]},"references-count":60,"alternative-id":["10.3389\/fmed.2026.1831400"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1831400","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,26]]},"article-number":"1831400"}}