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Intermittent Pneumatic Compression Stocking Prophylaxis Against Deep Venous Thrombosis in Anterior Cervical Spinal Surgery: A Prospective Efficacy Study in 200 Patients and Literature Review

Epstein, Nancy E., MD

doi: 10.1097/01.brs.0000186318.80139.40
Cervical Spine
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Study Design. Intermittent 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.

Objectives. To determine the optimal prophylaxis against DVT and PE for patients undergoing anterior cervical spinal surgery.

Background Data. Mini-heparin and low-dose heparin prophylaxis in neurosurgery poses a 2% to 4% risk of major postoperative hemorrhage with resultant neurologic sequelae.

Methods. Prophylaxis 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.

Results. One 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).

Conclusions. IPCs 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.

Intermittent pneumatic compression stockings provided safe and effective prophylaxis against deep venous thrombosis (DVT) and pulmonary embolism (PE) in 2 anterior cervical operative series. Only 1 of 100 patients undergoing single-level anterior corpectomy/fusion (ACF) developed DVT/PE (factor V mutation hypercoagulopathy). Although 7 of 100 having multilevel ACF/posterior fusion developed DVT, only 2 of 7 with iliac vein DVT developed PE.

From the Department of Neurological Surgery, Albert Einstein College of Medicine, Bronx, NY; and Division of Neurological Surgery, Winthrop University Hospital, Mineola, NY.

Acknowledgment date: August 23, 2004. First revision date: December 5, 2004. Acceptance date: January 11, 2005.

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

Institutional funds were received in support of this work. Although one or more of the author(s) has/have received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this manuscript, benefits will be directed solely to a research fund, foundation, educational institution, or other nonprofit organization which the author(s) has/have been associated.

Address correspondence and reprint requests to Nancy E. Epstein, MD, Long Island Neurosurgical Assoc., P.C., 410 Lakeville Rd., Suite 204, New Hyde Park, NY 11042; E-mail: dch3@columbia.edu

© 2005 Lippincott Williams & Wilkins, Inc.