• Takashi Imuro and Mitsuru Saito.
• Department of Orthopedic Surgery, Atsugi City Hospital, Kana-gawa, Japan.
• Spine. 2022 Feb 1; 47 (3): E116E123E116-E123.

Study DesignProspective cohort study.ObjectiveThe aim of this study was to assess preoperative factors in the development/exacerbation of deep vein thrombosis (DVT) in lumbar surgery and selectively perform lower-extremity venous ultrasonography (US) in patients at risk of perioperative deep vein thrombosis (DVT).Summary Of Background DataDVT is often present before lumbar surgery and also can develop or is exacerbated postoperatively. An elevated d-dimer level is predictive of DVT but not in all patients or during every operative period. The level of the thrombogenic marker soluble fibrin monomer complex (SFMC) peaks early postoperatively.MethodsThe study enrolled 698 patients (396 males; 12- 91 years [346 patients aged ≥70 years] at surgery) undergoing surgery for lumbar degenerative diseases. Patients with d-dimer levels ≥0.5 μg/mL or with a lower-extremity manual muscle test (MMT) < grade 3 underwent preoperative US. All preoperative DVT-positive patients and patients with SFMC levels ≥20 μg/mL on postoperative day 1 (POD1) underwent US. Patients with pre- and postoperative femoral-vein DVT underwent screening for pulmonary embolism (PE).ResultsThere were 251 patients with preoperative d-dimer levels ≥ 0.5 μg/mL, including 226 with MMT ≥ grade 3, 38 (16.8%) of whom were DVT-positive on US. In 48 patients with MMT ConclusionPreoperative DVT screening by US is advisable for patients with elevated d-dimer levels, lower extremities with MMT < grade 3, or DVT positivity. Postoperative US is advisable for patients with elevated SFMC levels on POD1.Level of Evidence: 3.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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