Thromboembolic Complications Following Spine Surgery Assessed with Spiral CT Scans

DVT/PE Following Spine Surgery

Han Jo Kim, MD
Department of Orthopedic Surgery, Hospital for Special Surgery


Sarah Walcott-Sapp, BA
Department of Orthopedic Surgery, Hospital for Special Surgery


Helene Pavlov, MD, FACR

Radiologist-in-Chief Emeritus, Hospital for Special Surgery

Oheneba Boachie-Adjei, MD

Chief Emeritus of Scoliosis Service, Hospital for Special Surgery
Attending Orthopedic Surgeon, Hospital for Special Surgery
Professor of Orthopedic Surgery, Weill Cornell Medical College

Geoffrey H. Westrich, MD

Associate Attending Orthopedic Surgeon, Hospital for Special Surgery
Research Director of Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery
Assistant Scientist, Hospital for Special Surgery
Co-Chairman, Complex Case Review Panel, Hospital for Special Surgery
Associate Professor of Clinical Orthopedic Surgery, Weill Cornell Medical College

Abstract

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.

This article appears in HSS Journal: Volume 7, Number 1.
View the full article at springerlink.com.

About the HSS Journal
HSS Journal, an academic peer-reviewed journal, is published twice a year, February and September, and features articles by internal faculty and HSS alumni that present current research and clinical work in the field of musculoskeletal medicine performed at HSS, including research articles, surgical procedures, and case reports.


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