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Kotwal, Suhel; Pumberger, Matthias; Lebl, Darren; Girardi, Fredrico; Zhiang, Kai; Salvati, Eduardo; Taveras, Nicole; James, Michelle; Cammisa, Frank

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Spine Journal Meeting Abstracts: October 2011 - Volume - Issue - [no page #]
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INTRODUCTION: Numerous articles have reported pulmonary embolism(PE) as a complication of spine surgery, but to our knowledge no publication has investigated the genetic factors associated with PE after spine surgery. This study is to assess the prevalence of genetic abnormalities for thrombophilia and hypofibrinolysis in patients in whom PE developed after spinal surgery,in comparison to a matched control group of patients who did not develop PE.

METHODS: Spinal surgery patients with post‐operative PE and matched control patients who had spinal surgery without any clinical indication of thromboemblism were evaluated for risks of thrombophilia and hypofibrinolysis. There are total 25 spinal surgery patients in which 13 patients had pulmonary embolism and 12 patients had no indication for PE. The patients PE were evaluated by spiral CT. Both groups patients were evaluated for thrombophilic and hypofibrinolytic risk factors with tests included:homocysteine, Antithrombin III, Protein C, ACT protein, Plasminogen activator inhibitor‐1 4G/4G, and Prothrombin 3UT gene mutation

RESULTS: The number of genetic thrombophilic abnormalities identified was higher in the pulmonary embolism group(13 abnormalities) than in the control group(7 abnormalities). Only patient with PE were found to have heterozygosity for the plasminogen activator inhibitor‐1(2 of 13 patients;p=0.05 compared with the control group). Patients with PE were much more likely than control group patients to have at least 1 thrombophilic abnormality(9 of 13) compared with control group(6 of 12). Genetic thrombophilia and hypofibrinolysis were more frequent in patients who had PE after spinal surgery than in those who had not. The presence of prothrombin 3' UT gene mutation appears to be risk factor for PE in patients undergoing spinal surgery. Currently these tests are rarely available and costly. Their use will help in the preoperative identification of patients with predisposition for PE after spinal surgery.

© 2011 Lippincott Williams & Wilkins, Inc.