Thromboembolic disease after combined anterior/posterior reconstruction for adult spinal deformity: a prospective cohort study using magnetic resonance venography.
METHODS
Thromboembolic disease (TED) after anterior/posterior spinal reconstructions was prospectively evaluated in 66 consecutive patients.


OBJECTIVE
Determine the incidence of TED after anterior/posterior spinal reconstruction.


BACKGROUND
Few studies have examined the rate of TED after potentially high-risk combined anterior/posterior reconstructions. Magnetic resonance venography (MRV) is more effective at detecting pelvic deep venous thrombosis (DVT) than conventional screening, but has not been used in these patients.


METHODS
We undertook a prospective cohort study of 66 consecutive adult patients (mean, 52.7 +/- 9.6 years) undergoing combined anterior/posterior spinal reconstructions for spinal deformity. All patients received only mechanical DVT prophylaxis. After surgery, MRV and bilateral lower extremity Doppler ultrasounds were obtained to screen for DVT, and contrast-enhanced spiral computed tomography scans were obtained for clinical suspicion of pulmonary embolism (PE).


RESULTS
The total incidence of postoperative TED was 13.6% (9 patients). The overall rate of DVT was 9.1% (6 patients), one-third occurring in the pelvis. PE developed in 7.6% (5 patients). In 2 patients, PE developed less than 48 hours after positive dopplers. In 3 patients, PE developed despite negative screening studies. Right-sided thoracoabdominal approaches were associated with an increased risk of developing DVT (P = 0.03, Odds Ratio 9.8), PE (P = 0.01, Odds Ratio 20), and TED (P = 0.004, Odds Ratio 12).


CONCLUSIONS
We report a high rate of TED after extensive anterior/posterior spinal reconstructions, for which a right-sided thoracoabdominal approach is an independent risk factor and screening ineffective at preventing PE. These patients should be considered at high risk for postoperative TED.
Piasecki
Dana P
DP
Hospital for Special Surgery, New York, NY 10021, USA. piaseckid@hss.edu
Poynton
Ashley R
AR
Mintz
Douglas N
DN
Roh
Jeffrey S
JS
Peterson
Margaret G E
MG
Rawlins
Bernard A
BA
Charles
Gina
G
Boachie-Adjei
Oheneba
O
D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010690:Phlebography / Q000379:methods; D011183:Postoperative Complications / Q000473:pathology / Q000601:surgery; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods*; D013116:Spinal Cord / Q000002:abnormalities* / Q000473:pathology / Q000601:surgery*; D013923:Thromboembolism / Q000209:etiology / Q000473:pathology / Q000601:surgery*