Analysis of measured D-dimer levels for detection of deep venous thrombosis and pulmonary embolism after spinal surgery.
METHODS
A retrospective clinical study.


OBJECTIVE
To show the prevalence of deep venous thrombosis (DVT) and pulmonary embolism (PE) after spinal surgery using a D-dimer assay followed by screening with computed tomographic (CT) pulmonary angiography and CT venography.


BACKGROUND
A few studies on DVT development after spinal surgery have been reported.


METHODS
A complete surveillance examination for DVT and PE was conducted in 88 patients who underwent spinal surgery [male patients, 48; female patients, 40; average age at operation, 62.4 y (range, 17 to 85 y)] through a D-dimer assay combined with CT pulmonary angiography and CT venography. The operation levels were the cervical spine (21 cases), the thoracic spine (16 cases), and the lumbar spine (51 cases). We adopted a D-dimer cut-off point of 10 μg/mL, and classified the patients into high D-dimer (HD; D-dimer level ≥10 μg/mL) and low D-dimer (LD; D-dimer level <10 μg/mL) groups.


RESULTS
Nine (10.2%) patients showed D-dimer levels of ≥10 μg/mL (HD group); of these, 5 patients (5.7%) had DVT. Two (2.2%) of the 5 DVT patients had PE. DVT was evident in 1 (6.2%) of the 16 patients who underwent thoracic procedures and 4 (7.8%) of the 51 patients who underwent lumbar procedures. Statistical comparison between the HD (excluding 5 patients with DVT or PE) and LD groups showed a significant difference in intraoperative blood loss between the groups (P=0.02).


CONCLUSIONS
The D-dimer assay was useful in predicting DVT development. A D-dimer level of ≥10 μg/mL is considered to be a risk factor for thromboembolic disease after spinal surgery. False-positive cases of thromboembolic disease preclude the use of this assay as a stand-alone test for DVT diagnosis. CT venography and CT pulmonary angiography are recommended to confirm thromboembolic disease.
Yoshiiwa
Toyomi
T
Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Japan.
Miyazaki
Masashi
M
Takita
Chikahiro
C
Itonaga
Ichiro
I
Tsumura
Hiroshi
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006801:Humans; D007796:Laminectomy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood* / Q000175:diagnosis; D011655:Pulmonary Embolism / Q000097:blood* / Q000175:diagnosis; D012189:Retrospective Studies; D020246:Venous Thrombosis / Q000097:blood* / Q000175:diagnosis; D055815:Young Adult
D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D