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Deep vein thrombosis after major reconstructive spinal surgery . STUDY DESIGN A prospective study was performed . OBJECTIVES The goals of the study were to determine the incidence of deep vein thrombosis after major adult spinal surgery and the optimal mode of prophylaxis in this surgical population . SUMMARY OF BACKGROUND DATA Few studies have evaluated deep vein thrombosis incidence and prophylaxis after major adult spinal surgery . Incidence rates have ranged from 0.9-14 % . METHODS Three hundred twenty-nine patients were evaluated . One hundred ten patients were randomized to 3 different deep vein thrombosis prophylaxis groups . These patients had duplex doppler scans between the fifth and seventh postoperative days . The remaining 219 patients formed a nonrandomized group and received either thrombosis embolic deterrent stockings alone or thrombosis embolic deterrent stockings and pneumatic compression boots for deep vein thrombosis prophylaxis . The type of deep vein thrombosis prophylaxis in this group was based on surgeon preference . All 329 patients were followed for clinical signs and symptoms of thromboembolic disease . Patients were followed clinically for a minimum of 1 year . RESULTS All 110 prophylaxis study group patients were clinically asymptomatic and 109 duplex scans were normal . One scan was indeterminate and a follow-up venogram was negative . Two patients in the coumadin group ( 5.7 % ) experienced excessive blood loss . One of the 219 patients from the nonrandomized group developed a clinically detectable proximal deep vein thrombosis which was confirmed by duplex ultra-sonography . The overall clinical incidence of deep vein thrombosis was 0.3 % ( 1 in 329 patients ) . CONCLUSIONS This low 0.3 % rate is in agreement with recent studies that focus on thromboembolic disease . Given the low incidence , routine screening for asymptomatic thrombi appears unwarranted . In addition , mechanical prophylaxis with graduated compression stockings and pneumatic compression boots is preferable to anticoagulation therapy .
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Intervention_Physical
duplex doppler scans
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Intervention_Physical
thrombosis embolic deterrent stockings alone
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Intervention_Physical
thrombosis embolic deterrent stockings and pneumatic compression boots
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Outcome_Physical
Deep vein thrombosis
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Outcome_Physical
deep vein thrombosis
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Outcome_Physical
deep vein thrombosis
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Outcome_Physical
prophylaxis
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Outcome_Physical
deep vein thrombosis prophylaxis
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Outcome_Physical
duplex doppler scans
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Outcome_Physical
clinical signs and symptoms of thromboembolic disease .
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Outcome_Physical
asymptomatic
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Outcome_Other
duplex scans
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Outcome_Physical
excessive blood loss
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Outcome_Physical
clinically detectable proximal deep vein thrombosis
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Outcome_Other
duplex ultra-sonography
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Outcome_Physical
deep vein thrombosis
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Outcome_Physical
thromboembolic disease
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Participant_Condition
Deep vein thrombosis
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Participant_Condition
major reconstructive spinal surgery
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Participant_Condition
deep vein thrombosis
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Participant_Condition
major adult spinal surgery
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Participant_Condition
major adult spinal surgery
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Participant_Sample-size
Three hundred twenty-nine
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Participant_Sample-size
One hundred ten