Incidence of symptomatic pulmonary embolism in spinal surgery

Background: Pulmonary embolism (PE) is a serious condition in orthopedic surgery. The incidence of PE, which is a sequelae of VTE in spinal surgery, is quite low. In the limited available published data, incidence rates of PE in spinal surgery are comparable to that of hip or knee arthroplasty surgery. The role of pharmacologic thomboprophylaxis remains controversial in spinal surgery. Objective: The present study was designed to evaluate the incidence of symptomatic pulmonary embolism in spinal urgery at a single tertiary care institute. Material and Method: A retrospective study of the medical records of patients that were diagnosed with symptomatic pulmonary embolism in spinal surgery from 2002-2012. The reviewed data were retrieved from the database of the Faculty of Medicine Siriraj Hospital, Mahidol University in Bangkok, Thailand. Results: Three cases of symptomatic pulmonary embolism were found from 9,184 spinal surgery cases. The incidence rate was 0.033%. There were two patients with lumbar spine surgery and one case with thoracolumnbar surgery. All three cases had different underlying conditions, operations, and clinical course. One case of fatal pulmonary embolism was found in our study. Conclusion: Although there is a very low incidence of symptomatic pulmonary embolism, this is a catastrophic condition for affected patients and their families. PE can occur in spinal surgery cases at all levels of severity and complexity, even with no apparent risk factors.