Rokito SE, Schwartz MC, Neuwirth MG.
Deep vein thrombosis after major reconstructive spinal surgery.
Spine 1996 Apr 1;21(7):853-8; discussion 859

Department of Spine Surgery, Hospital for Joint Diseases, Orthopaedic Institute,
New York, New York, USA.

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.