• Nancy E Epstein.
• Department of Neurological Surgery, Albert Einstein College of Medicine, Bronx, NY, USA. dch3@columbia.edu
• Spine. 2005 Nov 15; 30 (22): 2538-43.

Study DesignIntermittent pneumatic compression stockings (IPC) alone were prospectively used to avoid deep venous thrombosis (DVT) and pulmonary embolism (PE) in 100 consecutive patients undergoing single-level anterior corpectomy/fusion (ACF) and in 100 patients having multilevel ACF/posterior fusion.ObjectivesTo determine the optimal prophylaxis against DVT and PE for patients undergoing anterior cervical spinal surgery.Background DataMini-heparin and low-dose heparin prophylaxis in neurosurgery poses a 2% to 4% risk of major postoperative hemorrhage with resultant neurologic sequelae.MethodsProphylaxis consisted of IPC alone. Doppler studies of the lower extremities were routinely obtained 2 days after surgery. Single-level ACF (100 patients) addressed two-level disc disease, spondylostenosis, and ossification of the posterior longitudinal ligament (OPLL). One hundred patients undergoing multilevel ACF (3+ levels) with posterior fusion (C2-T1) exhibited OPLL/spondylostenosis.ResultsOne patient undergoing single-level ACF developed DVT/PE 6 days after surgery; she exhibited Factor V Leiden mutation (hypercoagulability syndrome). Although 7 patients undergoing circumferential surgery developed DVT 2 to 14 days following surgery (mean, 7.15 days), only two clots localized in the iliac veins resulted in PEs (days 10 and 14 after surgery).ConclusionsIPCs were as effective for prophylaxis against DVT/PE for 100 patients undergoing single-level ACF and for 100 having circumferential procedures as existing therapies (mini-heparin and low-dose heparin), without the risk of hemorrhage. However, the 1% and 2% respective rates of PE were comparable to frequencies of PE encountered in other cranial/spinal series using mini-heparin and/or low-dose heparin regimens but avoided the 2% to 4% risk of major postoperative hemorrhage.

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