The Journal of Bone and Joint Surgery, Vol 76, Issue 7 980-985, Copyright © 1994 by Journal of Bone and Joint Surgery, Inc
Deep venous thrombosis and pulmonary embolism after major reconstructive operations on the spine. A prospective analysis of three hundred and seventeen patients
MD Smith, EL Bressler, JE Lonstein, R Winter, MR Pinto and F Denis
Minnesota Spine Center, Minneapolis 55454.
We performed a prospective study of 317 patients in order to determine the
prevalence of deep venous thrombosis after reconstructive operations on the
spine; 126 of the patients were examined with duplex ultrasound assessments
of the lower extremities to ensure that no asymptomatic thrombi were being
missed. Thigh-high stockings and sequential pneumatic compression of the
lower extremities were used, in all patients, for prophylaxis against
venous thrombosis. No antiplatelet agents or anticoagulant medications were
administered. There was no evidence of thrombosis on any of the duplex
ultrasound studies. Subsequently, venous thrombosis developed and was
treated successfully in one of the 126 tested patients and in one of the
191 untested patients, and a fatal pulmonary embolus developed in one of
the untested patients. The over-all clinical prevalence of thrombotic
complications was 0.9 per cent (three complications in 317 patients). All
three of the patients who had clinical evidence of thrombosis had had an
anterior lumbar procedure because of a degenerative disorder or trauma;
however, we could not prove that this approach or these diagnoses were
significant risk factors for thrombosis (p < 0.05). While it is possible
that some thrombi may have escaped both clinical and ultrasonic detection,
such thrombi apparently were not enough of a danger to warrant the use of
intensive prophylactic procedures that are associated with more risk. On
the basis of this prospective study, therefore, we think that routine
screening for the detection of asymptomatic thrombosis in patients who have
had a procedure on the spine is unwarranted.
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