| Pulmonary Embolism Diagnosed on Computed Tomography Contrast Angiography Despite Negative Venous Doppler Ultrasound After Spinal Surgery. | |
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MedLine Citation:
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PMID: 21336179 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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STUDY DESIGN: The focus of this study was on the frequency of negative initial/subsequent ultrasound (US) of the lower extremities but positive spinal computed tomography contrast angiography (CTA) diagnostic of pulmonary embolism (PE) among 75 patients undergoing cervical laminectomy/fusion and 165 patients having lumbar laminectomy/noninstrumented fusion. OBJECTIVE: To determine the percentage/incidence of patients undergoing spinal surgery with negative US but with positive CTA. SUMMARY OF BACKGROUND DATA: The frequency of patients with negative US but with positive CTA after spinal surgery is not well documented. METHODS: For 240 spinal surgery patients, postoperative prophylaxis against deep venous thrombosis consisted of alternating pneumatic compression stockings alone. The patients were routinely screened on postoperative days 1 to 2 for deep venous thrombosis using US. The incidence of initial/subsequent negative US and positive CTA diagnostic for PE in patients with mild/major symptoms was evaluated, in conjunction with the frequency of hypercoagulation syndromes. RESULTS: Five (6.7%) patients undergoing cervical surgery and 6 patients (3.6%) undergoing lumbar surgery exhibited negative US but positive CTA on postoperative days 1 to 21. All the patients immediately received inferior vena cava filters (2 permanent and 9 retrievable). Five patients (45%) tested positive for hypercoagulation syndromes. Two patients were fully anticoagulated on postoperative days 3 and 21 with major symptoms attributed to saddle emboli; 1 had hypercoagulation syndrome. Anticoagulation was delayed for 6 to 12 weeks in 7 patients with milder symptoms, as magnetic resonance imaging scans showed residual seromas; 4 had hypercoagulation syndromes. Two elderly patients, at high risk for falls, without hypercoagulation syndromes were not anticoagulated. CONCLUSIONS: The frequency of negative US of the lower extremities but with positive CTA for PE after 240 cervical/lumbar spinal procedures in patients with mild/major symptoms ranged from 3.6% to 6.7%; 5 of the 11 patients exhibited hypercoagulation syndromes. To avoid failure to diagnose PE after spinal surgery, one should have a "low threshold" (eg, based even on minor symptoms) for requesting the CTA. |
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Authors:
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Nancy E Epstein; Harry Staszewski; Michael Garrison; Man Hon |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-2-17 |
Journal Detail:
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Title: Journal of spinal disorders & techniques Volume: - ISSN: 1539-2465 ISO Abbreviation: - Publication Date: 2011 Feb |
Date Detail:
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Created Date: 2011-2-21 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101140323 Medline TA: J Spinal Disord Tech Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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*Neurological Surgery, The Albert Einstein College of Medicine, Bronx ∥Division of Hematology/Oncology ‡Medicine ♯Radiology, Stony Brook University Hospital, Stony Brook †Neurosurgical Spine and Education §Division of Oncology/Hematology, Department of Medicine Departments of ¶Medicine **Radiology, Winthrop University Hospital, Mineola, NY. |
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