Preoperative Lower Extremity Motor Weakness Affects Deep Vein Thrombosis During the Perioperative Period of Lumbar Surgery

Abstract

Study Design. Prospective cohort study.Objective. The 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 Data. DVT 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. Methods. The 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 mg/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 mg/mL on postoperative day 1 (POD1) underwent US. Patients with pre-and postoperative femoral-vein DVT underwent screening for pulmonary embolism (PE). Results. There were 251 patients with preoperative D-dimer levels ! 0.5 mg/mL, including 226 with MMT ! grade 3, 38 (16.8%) of whom were DVT-positive on US. In 48 patients with MMT < grade 3, DVT was detected in 16 of 25 patients with Ddimer levels ! 0.5 mg/mL (64.0%) and 10 of 23 with D-dimer levels <0.5 mg/mL (43.5%). Postoperatively, 26 of 64 preoperative DVT-positive patients (40.6%) had postoperative exacerbation of DVT; PE occurred in three. Among 100 of 634 preoperative DVT-negative patients, US revealed new DVT in 14 (2.2%) and PE in one. Preoperative DVT and new postoperative DVT were significantly more common in patients aged !70 years; postoperative DVT exacerbation was significantly more common in patients aged <70 years. A significantly higher proportion of patients with motor weakness had preoperative DVTs and postoperative exacerbated or new DVTs. Conclusion. Preoperative 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.

Analysis of Risk Factors for Postoperative Deep Vein Thrombosis in Traumatic Spinal Fracture Complicated with Spinal Cord Injury

“…Some scholars have studied the ossi cation of the posterior longitudinal ligament with acute spinal cord injury, showing that the impairment of lower limb motor function is a risk factor for DVT in the lower limbs. 26 Imyro et al 27 research 698 lumbar degenerative surgeries found that preoperativelower extremity < 3 was closely associated with the occurrence of DVT, which was consistent with our results. 27 Patients with spinal cord injury with dinnervation, complete loss of movement and sensation below the plane of injury, incomplete SCI patients with lower limb motor dysfunction.Our study patients with lower extremity < 3, the risk of postoperative DVT increased 10-fold.Therefore, patients admitted with lower extremity < 3 should take active measures to prevent DVT and reduce its incidence.…”

Risk Factors for Venous Thrombosis after Spinal Surgery: A Systematic Review and Meta-analysis

“…Five investigations comprising 1671 patients found a link between preoperative walking dysfunction and the occurrence of VTE following spine surgery [ 30 – 33 , 36 ], with 82 patients having walking dysfunction, 1589 having no walking dysfunction, 168 having VTE (+), and 1503 having VTE (-). Since there was no statistical heterogeneity across the studies, the fixed effect model was used in the meta-analysis.…”