Venous thromboembolism (VTE) is a source of morbidity and mortality in patients undergoing orthopaedic surgery. A substantial body of literature supports the use of VTE prophylactic agents in patients undergoing lower extremity surgery. Treatment options include early mobilization, mechanical prophylaxis via pneumatic compression devices, pharmacologic agents, and venous filters. No consensus has been established regarding utilization or timing of VTE prophylaxis measures after spine surgery. The risk of VTE in patients undergoing spine surgery is not well characterized and varies substantially by the procedure and degree of neurologic compromise. In addition, the risk of clinically notable VTE must be weighed against the risk of postoperative bleeding and epidural hematoma after spine surgery. A standardized approach to VTE prophylaxis in patients undergoing spine surgery must take into account the available studies of risk factors, choice of prophylactic agents, and timing of prophylaxis.