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Deep vein thrombosis after major reconstructive spinal surgery

S E Rokito1, M C Schwartz, M G Neuwirth

  • 1Department of Spine Surgery, Hospital for Joint Diseases, Orthopaedic Institute, New York, New York, USA.

Spine
|April 1, 1996
PubMed
Summary

Deep vein thrombosis (DVT) occurs rarely after major adult spinal surgery, with an incidence of 0.3%. Mechanical prophylaxis using compression stockings and boots is recommended over anticoagulation for DVT prevention.

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Area of Science:

  • Orthopedics
  • Vascular Surgery
  • Thromboembolic Disease

Background:

  • Deep vein thrombosis (DVT) incidence after major adult spinal surgery is not well-established, with reported rates varying widely from 0.9% to 14%.
  • Limited research exists on optimal DVT prophylaxis strategies in this specific patient population.

Purpose of the Study:

  • To determine the incidence of deep vein thrombosis (DVT) following major adult spinal surgery.
  • To identify the most effective mode of DVT prophylaxis for patients undergoing major adult spinal surgery.

Main Methods:

  • A prospective study involving 329 adult patients undergoing major spinal surgery.
  • 110 patients were randomized into three prophylaxis groups; 219 patients received prophylaxis based on surgeon preference.
  • Postoperative duplex Doppler scans were performed on a subset of patients, and all patients were monitored for clinical signs of thromboembolic disease for at least one year.

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Main Results:

  • The overall clinical incidence of deep vein thrombosis (DVT) was low at 0.3% (1 in 329 patients).
  • In the prophylaxis study group, only one patient had an indeterminate scan, with a negative follow-up venogram.
  • Two patients (5.7%) in the anticoagulation (coumadin) group experienced excessive blood loss, while one patient in the non-randomized group developed detectable proximal DVT.

Conclusions:

  • The low incidence of DVT (0.3%) suggests that routine screening for asymptomatic thrombi may not be necessary.
  • Mechanical prophylaxis, including graduated compression stockings and pneumatic compression boots, is a preferred method for DVT prevention in this patient population compared to anticoagulation therapy.