Intermittent pneumatic compression stocking prophylaxis against deep venous thrombosis in anterior cervical spinal surgery - A prospective efficacy study in 200 patients and literature review

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.