Rapidly progressive cervical myelopathy had a high risk of developing deep venous thrombosis: a prospective observational study in 289 cases with degenerative cervical spine disease.

STUDY

DESIGN

A prospective observational study.

OBJECTIVES

To determine the incidence of deep venous thrombosis (DVT) and to evaluate the risk factors for DVT development associated with degenerative cervical spine disease.

SETTING

Hokkaido Spinal Cord Injury Center, Japan.

METHODS

Between April 2008 and March 2015, patients with degenerative cervical spine disease, such as compressive myelopathy or radiculopathy, who underwent surgical treatment were prospectively assessed. Leg vein ultrasonography and D-dimer tests were performed preoperatively and at 4 days after surgery. All patients received treatment with intermittent pneumatic compression and elastic stockings for primary DVT prophylaxis. No anticoagulation medications were used for DVT prophylaxis.

RESULTS

A total of 289 patients (203 males, 86 females; median age: 67 years (interquartile range, 58-76)) were included. Nine patients (3.1%) exhibited DVT during the perioperative period. All 9 cases were women who had distal DVT. The incidences of preoperative and postoperative DVT were 1.1% and 2.1%, respectively. The univariate analysis showed that statistically significant risk factors for perioperative DVT included female gender (P < 0.01), advanced age (P = 0.04), a low Japanese Orthopaedic Association score (P = 0.03), rapidly progressive myelopathy (P < 0.01), and inability to walk (P = 0.01). The multivariate analysis showed that rapidly progressive myelopathy (P = 0.04) was the most important risk factor.

CONCLUSION

Female gender and rapidly progressive myelopathy are high-risk factors that predict the development of DVT during the perioperative period of cervical spine surgery. This result indicates that screening and treatment for DVT are needed in such high-risk patients.