Acute deep venous thrombosis induced by May-Thurner syndrome after spondylolisthesis surgery: A case report and review of literature

Abstract

BACKGROUND Deep venous thrombosis (DVT) is a serious complication of lumbar spine surgery. Current guidelines recommend pharmacomechanical prophylaxis for patients at high risk of DVT after spine surgery. May-Thurner syndrome (MTS), a venous anatomical variation that may require invasive intervention, is an often overlooked cause of DVT. To date, no case reports of symptomatic MTS caused by isthmic spondylolisthesis or subsequent acute DVT after posterior lumbar surgery have been published. CASE SUMMARY We here present a case of a patient who developed acute DVT 4 h after spondylolisthesis surgery, and MTS was only considered after surgery, during a review of a gynecological enhanced computed tomography image taken before the procedure. CONCLUSION In conclusion, clinicians should consider MTS in the presence of a dangerous triad: spondylolisthesis, elevated D-dimer levels, and sonographically indicated unilateral deep vein dilation. Consultation with a vascular surgeon is also essential to MTS management.

Lumbar overlordosis — towards the better understanding of the May-Thurner syndrome pathogenesis

“…As mentioned above, the presence of iliac vein compression can increase the risk of the proximal, iliofemoral DVT. The estimated prevalence of the MTS related DVT (mostly iliofemoral DVT) in the whole DVT population is relatively low: 2-3% [17,18], however, much higher in the patients with left leg proximal iliofemoral DVT. This observation is linking the iliac vein compression and its intraluminal abnormalities with the obstructive compound of the Virchow triad [19,20].…”