Katsuhito Yoshioka, Department of Orthopaedic Surgery, Kanazawa University, Kanazawa, Japan, and others reported at Spineweek that while surgery for spinal tumours is associated with a high risk of venous thromboembolism (VTE), cervical spinal surgery is associated with a comparatively low risk of VTE
Yoshioka said: “There is a growing recognition that VTE is a serious complication after spinal surgery. Although there are some studies of VTE after spinal surgery, they have limitations. The biggest problem is that various kinds of disease were estimated together [ie, scoliosis and tumour].” The aim of Yoshioka et al’s study was to demonstrate the incidence and identify the risk factors for VTE after different types of spinal surgery.
Yoshioka et al assessed 340 patients who underwent spinal surgery between October 2008 and March 2011, and these patients were spilt info four groups:decompression (for lumbar spinal stenosis, 79); fusion (for lumbar and/or lower thoracic degenerative disease, 90); cervical (decompression and/or fusion for patients with cervical degenerative disease, 89); and tumour (en bloc spondylectomy or piecemeal excision with stabilisation for spinal tumour, 82). All patients received mechanical prophylaxis (compression stockings and intermittent pneumatic compression devices) and were screened for signs of VTE using duplex ultrasonography and lung perfusion scintigraphy seven to 10 days after surgery. If VTE was suspected, multidetector computed tomography venography was also used.
Yoshioka reported: “The overall incidence of VTE was 13.8%; deep vein thrombus was 11.8% and pulmonary thromboembolism (PTE) was 2.9%.” He added that the incidence of VTE was 15.2% in the decompression group, 13.3% in the fusion group, 4.5% in the cervical group, and 22% in the tumour group, noting “Spinal tumour had a high risk of VTE. In contrast, the surgery in the cervical level has low risk of it.”
The high risk of VTE in the tumour group, Yoshioka said, was a combination of several factors–including the paralysis that occurred as a result of the spinal cord compression caused by the tumour. Aside from spinal tumours, intraoperative blood loss, duration of blood loss, and neurologic deficit were also identified as significant risk factors for VTE after spinal surgery.
Yoshioka told Spinal News International it needed to be emphasised that the risk of VTE differed according to level of the spinal condition. He added: “We have to screen for both DVT and PTE in high-risk patients because 60% of PTE patients had no DVT.”