Deep vein thrombosis after major reconstructive spinal surgery.
METHODS
A prospective study was performed.


OBJECTIVE
The goals of the study were to determine the incidence of deep vein thrombosis after major adult spinal surgery and the optimal mode of prophylaxis in this surgical population.


BACKGROUND
Few studies have evaluated deep vein thrombosis incidence and prophylaxis after major adult spinal surgery. Incidence rates have ranged from 0.9-14%.


METHODS
Three hundred twenty-nine patients were evaluated. One hundred ten patients were randomized to 3 different deep vein thrombosis prophylaxis groups. These patients had duplex doppler scans between the fifth and seventh postoperative days. The remaining 219 patients formed a nonrandomized group and received either thrombosis embolic deterrent stockings alone or thrombosis embolic deterrent stockings and pneumatic compression boots for deep vein thrombosis prophylaxis. The type of deep vein thrombosis prophylaxis in this group was based on surgeon preference. All 329 patients were followed for clinical signs and symptoms of thromboembolic disease. Patients were followed clinically for a minimum of 1 year.


RESULTS
All 110 prophylaxis study group patients were clinically asymptomatic and 109 duplex scans were normal. One scan was indeterminate and a follow-up venogram was negative. Two patients in the coumadin group (5.7%) experienced excessive blood loss. One of the 219 patients from the nonrandomized group developed a clinically detectable proximal deep vein thrombosis which was confirmed by duplex ultra-sonography. The overall clinical incidence of deep vein thrombosis was 0.3% (1 in 329 patients).


CONCLUSIONS
This low 0.3% rate is in agreement with recent studies that focus on thromboembolic disease. Given the low incidence, routine screening for asymptomatic thrombi appears unwarranted. In addition, mechanical prophylaxis with graduated compression stockings and pneumatic compression boots is preferable to anticoagulation therapy.
Rokito
S E
SE
Department of Spine Surgery, Hospital for Joint Diseases, Orthopaedic Institute, New York, New York, USA.
Schwartz
M C
MC
Neuwirth
M G
MG
D000293:Adolescent; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011312:Pressure; D011446:Prospective Studies; D013123:Spinal Fusion / Q000009:adverse effects*; D013131:Spine / Q000098:blood supply* / Q000601:surgery; D013924:Thrombophlebitis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000517:prevention & control; D014463:Ultrasonography; D014859:Warfarin / Q000627:therapeutic use
D000925:Anticoagulants; D014859:Warfarin