Thromboembolic Disease After Combined Anterior/Posterior Reconstruction for Adult Spinal Deformity

In Brief Study Design. Thromboembolic disease (TED) after anterior/posterior spinal reconstructions was prospectively evaluated in 66 consecutive patients. Objective. Determine the incidence of TED after anterior/posterior spinal reconstruction. Summary of Background Data. Few studies have examined the rate of TED after potentially high-risk combined anterior/posterior reconstructions. Magnetic resonance venography (MRV) is more effective at detecting pelvic deep venous thrombosis (DVT) than conventional screening, but has not been used in these patients. Methods. We undertook a prospective cohort study of 66 consecutive adult patients (mean, 52.7 ± 9.6 years) undergoing combined anterior/posterior spinal reconstructions for spinal deformity. All patients received only mechanical DVT prophylaxis. After surgery, MRV and bilateral lower extremity Doppler ultrasounds were obtained to screen for DVT, and contrast-enhanced spiral computed tomography scans were obtained for clinical suspicion of pulmonary embolism (PE). Results. The total incidence of postoperative TED was 13.6% (9 patients). The overall rate of DVT was 9.1% (6 patients), one-third occurring in the pelvis. PE developed in 7.6% (5 patients). In 2 patients, PE developed less than 48 hours after positive dopplers. In 3 patients, PE developed despite negative screening studies. Right-sided thoracoabdominal approaches were associated with an increased risk of developing DVT (P = 0.03, Odds Ratio 9.8), PE (P = 0.01, Odds Ratio 20), and TED (P = 0.004, Odds Ratio 12). Conclusion. We report a high rate of TED after extensive anterior/posterior spinal reconstructions, for which a right-sided thoracoabdominal approach is an independent risk factor and screening ineffective at preventing PE. These patients should be considered at high risk for postoperative TED. Magnetic Resonance Venography supplemented screening for thromboembolic disease in this prospective cohort after extensive combined anterior/posterior reconstructions. An elevated rate of deep venous thrombosis and pulmonary embolism was seen—particularly among right-sided anterior approaches—and with embolism occurring despite screening. These patients should be considered high-risk for the development of postoperative thromboembolic disease.