Thromboembolic Complications Following Spine Surgery Assessed with Spiral CT Scans
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Spine surgery is associated with a significant risk of postoperative pulmonary embolism (PE) and/or deep vein thrombosis (DVT). The goal of this study was to determine which symptoms and risk factors were associated with spiral CT scans positive for PE and/or DVT in the postoperative spine surgery patient. We conducted a retrospective review of all spine patients who underwent a postoperative CT to rule out PE during the period of March 2004–February 2006. The type of surgical procedure, risk factors, symptoms prompting scan ordering, anticoagulation, and treatment were recorded. Logistic regression models were used to determine significant predictors of a positive CT in this patient population. Of the 3,331 patients that had spine surgery during the study period, 130 (3.9%) had a spiral CT scan to rule out PE and/or proximal DVT. Thirty-three of the 130 (25.4%) CT scans were positive for PE only, five (3.8%) for PE and DVT, and three (2.3%) for DVT only. Only 24.5% (32) patients had risk factors for thromboembolic disease, and of these, a history of PE and/or DVT was the only significant risk factor for a positive scan (p = 0.03). No presenting symptoms or demographic variables were noted to have a significant association with PE and/or DVT. The type of surgical procedure (i.e., anterior, posterior, and percutaneous) was not associated with an increased risk for PE and/or DVT. Patients who are undergoing spine surgery with a history of thromboembolic disease should be carefully monitored postoperatively and may benefit from more aggressive prophylaxis.
- Audibert G, Faillot T, Vergnes MC, et al. Thromboprophylaxis in elective spinal surgery and spinal cord injury. Ann Fr Anesth Reanim 2005;24(8):928-34.
- Brambilla S, Ruosi C, La Maida GA, Caserta S. Prevention of venous thromboembolism in spinal surgery. Eur Spine J 2004;13(1):1-8. CrossRef
- Cain JE, Jr, Major MR, Lauerman WC, West JL, Wood KB, Fueredi GA. The morbidity of heparin therapy after development of pulmonary embolus in patients undergoing thoracolumbar or lumbar spinal fusion. Spine 1995;20(14):1600-03. CrossRef
- Catre MG. Anticoagulation in spinal surgery. A critical review of the literature. Can J Surg 1997;40(6):413-19.
- Dearborn JT, Hu SS, Tribus CB, Bradford DS. Thromboembolic Complications after Major Thoracolumbar Spine Surgery. Spine 1999;24(14):1471-76. CrossRef
- Epstein NE. Intermittent pneumatic compression stocking prophylaxis against deep venous thrombosis in anterior cervical spinal surgery: a prospective efficacy study in 200 patients and literature review. Spine 2005;30(22):2538-43. CrossRef
- Epstein NE. A review of the risks and benefits of differing prophylaxis regimens for the treatment of deep venous thrombosis and pulmonary embolism in neurosurgery. Surg Neurol 2005;64(4):295-301; discussion 302 CrossRef
- Epstein NE. Efficacy of pneumatic compression stocking prophylaxis in the prevention of deep venous thrombosis and pulmonary embolism following 139 lumbar laminectomies with instrumented fusions. J Spinal Disord Tech 2006;19(1):28-31. CrossRef
- Freedman KB, Brookenthal KR, Fitgerald RH, William S, Lonner JH. A meta-analysis of thromboembolic prophylaxis following elective total hip arthroplasty. J Bone Joint Surg [Am] 2000;82-A:929-38.
- Geerts W, Selby R. Prevention of venous thromboembolism in the ICU. Chest 2003;124(6 Suppl):357S-363S. CrossRef
- Geerts W, Cook D, Selby R, Etchells E. Venous thromboembolism and its prevention in critical care. J Crit Care 2002;17(2):95-104. CrossRef
- Ghaye B, Ghuysen A, Bruyere PJ, D'Orio V, Dondelinger RF. Can CT pulmonary angiography allow assessment of severity and prognosis in patients presenting with pulmonary embolism? What the radiologist needs to know. Radiographics 2006;26:23-39 CrossRef
- Leon L, Rodriguez H, Tawk RG, Ondra SL, Labropoulos N, Morasch MD. The prophylactic use of inferior vena cava filters in patients undergoing high-risk spinal surgery. Ann Vasc Surg 2005;19(3):442-47. CrossRef
- Lloyd NS, Douketis JD, Moinuddin I, Lim W, Crowther MA. Anticoagulant prophylaxis to prevent asymptomatic deep vein thrombosis in hospitalized medical patients: a systematic review and meta-analysis. J Thromb Haemost 2008;6(3):405-14. CrossRef
- Maurtua M, Zhang W, Deogaonkar A, Farag E, Ebrahim Z. Massive pulmonary thromboembolism during elective spine surgery. J Clin Anesth 2005;17(3):213-17. CrossRef
- Miniati M, Prediletto R, Formichi B, et al. Accuracy of clinical assessment in the diagnosis of pulmonary embolism. Am. J. Respir. Crit. Care Med 1999;159:864-71.
- Parvizi J, Smith EB, Pulido L, et al. The rise in the incidence of pulmonary embolus after joint arthroplasty: is modern imaging to blame? Clin Orthop Relat Res 2007;463:107-13.
- Rosner MK, Kuklo TR, Tawk R, Moquin R, Ondra SL. Prophylactic placement of an inferior vena cava filter in high-risk patients undergoing spinal reconstruction. Neurosurg Focus 2004;17(4):E6. CrossRef
- Stein PD, Henry JW. Clinical characteristics of patients with acute pulmonary embolism stratified according to their presenting syndromes. Chest 1997;112:974-79. CrossRef
- Wang SL, Nie Y, Wang C, Chen ZQ. Analysis the reasons of pulmonary embolism after spine surgery in eleven patients. Zhonghua Wai Ke Za Zhi 2007;45(20):1397-1400.
- Westrich GH, Haas SB, Mosca P, Peterson M. Meta-analysis of thromboembolic prophylaxis after total knee arthroplasty. J Bone Joint Surg [Br] 2000;82:795-800. CrossRef
- Thromboembolic Complications Following Spine Surgery Assessed with Spiral CT Scans
Volume 7, Issue 1 , pp 37-40
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- spine surgery
- spiral CT
- Industry Sectors
- Author Affiliations
- 1. Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
- 2. Department of Radiology, Hospital for Special Surgery, New York, NY, USA
- 3. Weill Cornell Medical College, New York, NY, USA