title: Pulmonary thromboembolism after spinal instrumentation surgery.
abstract: A 57-year-old woman was hospitalized because of gait disturbance and dysuria. Close examination revealed a cauda equina tumor at the level of L2 and L3. Tumor resection was performed, with posterolateral fusion and spinal instrumentation. On the eleventh day after the surgery, she experienced dyspnea and chest pain during standing and walking exercise. Pulmonary thromboembolism was diagnosed, based on: (1) blood gas analysis findings of hypoxemia and (2) defective images in both of the upper lobes on urgent pulmonary blood flow scintigram. Her clinical status improved with urgent thrombolytic therapy (with tisokinase and urokinase) and anticoagulation therapy (with heparin and warfarin), and her life was saved. When pulmonary thromboembolism occurs, early diagnosis by pulmonary blood flow scintigram and early thrombolytic and anticoagulative therapies are necessary. Special attention should be paid to symptoms of pulmonary thromboembolism in patients after spinal surgery.
authors.affiliation: Department of Orthopedic Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba 279-0021, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Arai
authors.forename: K
authors.initials: K
authors.lastname: Shitoto
authors.forename: T
authors.initials: T
authors.lastname: Muta
authors.forename: H
authors.initials: H
authors.lastname: Kurosawa
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D002420:Cauda Equina / Q000601:surgery*; D002637:Chest Pain / Q000209:etiology; D004417:Dyspnea / Q000209:etiology; D005260:Female; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D000860:Hypoxia / Q000209:etiology; D008159:Lumbar Vertebrae / Q000601:surgery; D008875:Middle Aged; D010524:Peripheral Nervous System Neoplasms / Q000601:surgery*; D010960:Plasminogen Activators / Q000627:therapeutic use; D011183:Postoperative Complications / Q000188:drug therapy; D011655:Pulmonary Embolism / Q000188:drug therapy / Q000209:etiology*; D013123:Spinal Fusion / Q000009:adverse effects / Q000295:instrumentation; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014859:Warfarin; D006493:Heparin; D010960:Plasminogen Activators; D010959:Tissue Plasminogen Activator; D014568:Urokinase-Type Plasminogen Activator