Thromboembolic Complications after Spinal Surgery

Abstract

Introduction: A review of the literature shows that deep venous thrombosis (DVT) and pulmonary embolism (PE) might be significant complications following spinal surgery. The incidence rate ranges from 0.5-2 % in patients with symptomatic thromboembolic disease and up to 15 % in patients with non-symptomatic thrombotic complications. The aim of this study was to analyse the incidence of symptomatic thromboembolism after spinal surgery in patients with postoperative systemic prophylaxis at this trauma centre and to determine general and specific risk factors for developing this disease, to allow the initiation of further prophylactic measures, if required. Material and Methods: The study retrospectively analysed the clinical records of all patients with surgical procedures at the spine, that were admitted to this level-I trauma centre between 1992 and 2002. Spinal procedures included anterior and/or posterior spinal fusion, video-assisted thoracoscopic fusion as well as spinal decompression. Symptomatic thromboembolic disease was diagnosed if patients showed significant clinical signs or symptoms of DVT or PE. In cases of DVT, diagnosis was confirmed by a duplex scan of the lower limbs, in cases of PE, by CT scans of the thorax or at post-mortem. Results: Clinical records showed 326 patients who underwent major spinal surgery. The incidence rate of symptomatic thromboembolic complications after operation was 1.2 % (n = 4). Two patients showed clinical signs of deep venous thrombosis, one of them developed pulmonary embolism subsequently. The other two patients developed pulmonary embolism without prior clinical signs of deep venous thrombosis. Finally, we had two cases of death following thromboembolic disease. Relating to the low number of thromboembolic complications encountered in this study, statistical significance of general or specific risk factors could not be demonstrated. Conclusion: Despite the rather low rate of clinically significant thromboembolic complications after spinal surgery, we recommend postoperative systemic anticoagulation prophylaxis in all patients from the first day after surgery as well as further prophylactic measures in patients with general or specific risk factors for best possible prevention.

Key words

spinal surgery - thromboembolic complications - risk factors - prophylaxis

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