Document Detail

Pulmonary Embolism Diagnosed on Computed Tomography Contrast Angiography Despite Negative Venous Doppler Ultrasound After Spinal Surgery.
MedLine Citation:
PMID:  21336179     Owner:  NLM     Status:  Publisher    
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.
Nancy E Epstein; Harry Staszewski; Michael Garrison; Man Hon
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-2-17
Journal Detail:
Title:  Journal of spinal disorders & techniques     Volume:  -     ISSN:  1539-2465     ISO Abbreviation:  -     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-2-21     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101140323     Medline TA:  J Spinal Disord Tech     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
*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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