Background:This prospective cohort study investigated the rate of venous thromboembolism (VTE) before and after spine surgery as determined with use of indirect multidetector computed tomography (MDCT).Methods:We performed a prospective study of 105 patients (36 women and 69 men ranging in age from 38 to 88 years) undergoing spine surgery at 2 institutions. Indirect MDCT was performed before and 3 days after surgery. Patients with a history of dialysis or drug allergy to contrast medium were excluded.Results:No patient had symptomatic VTE preoperatively or postoperatively. The preoperative and postoperative rates of asymptomatic VTE were 4.8% and 13.0%, respectively; the rates of asymptomatic pulmonary embolism were 2.9% and 8.0%, respectively; and the rates of asymptomatic deep venous thrombosis were 3.8% and 6.0%, respectively. Age, sex, height, weight, body mass index, operative time, volume of intraoperative blood loss, and specific comorbidities (diabetes, hypertension, cardiac disease, previous VTE, and previous anticoagulation treatment) were not found to be risk factors.Conclusions:Our findings demonstrated a low rate of preoperative VTE but a high rate of postoperative VTE in association with spine surgery. Surgeons need to be aware of the risk of VTE in patients undergoing spine surgery. MDCT is an effective and convenient technology for the early detection of VTE in such patients.Level of Evidence:Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence.

Purpose To examine the relationship between handgrip strength and leg extension power, walking speed, and intermittent claudication for lumbar spinal stenosis (LSS) using computed tomography. Methods We examined patients who underwent laminectomy for LSS from June 2015 through March 2018. Before spine surgery, we evaluated walking distance, handgrip strength, leg extension power (LEP), 10-m walk test (time and steps), psoas muscle index (PMI), and the area of both total and multifidus muscle using plain computed tomography imaging at the third lumbar level. Handgrip strength was compared with comorbidities including anemia, diabetes, hypertension, marital status, etc. Results There were 183 patients (55 female, 128 male) with a mean age of 70.5 years. Handgrip strength significantly correlated with LEP (P < 0.001, r = 0.723), walking speed (P < 0.001, r = − 0.269), 10-m walking test (steps) (P < 0.001, r = − 0.352), area of skeletal muscle at L3 level (P < 0.001, r = 0.469), area of psoas muscle (P < 0.001, r = 0.380), PMI (P < 0.001, r = 0.253), and intermittent claudication. Age, height, and weight were correlated with handgrip strength, but BMI was not correlated. Handgrip strength was significantly reduced by anemia, hypertension, and single marital status. Conclusions The more handgrip strength patients with LSS have, the more LEP, the faster walking speed, the greater area of psoas and skeletal muscle, the fewer steps for a 10-m walk they have, and the longer walking distance. Age, height, and weight were associated with handgrip strength, but BMI has no association. Low handgrip strength was related to comorbidities including anemia, hypertension, and marital status.

Introduction: Pulmonary embolism (PE) is a risk of mortality following spine surgery. Many studies have demonstrated that deep venous thrombosis (DVT) may affect and actually advance to PE, but few studies have shown how venous thromboembolism (VTE), including PE and DVT, affect blood markers after spine surgery. In this study, we examined changes in blood markers with PE or DVT after low-risk spine surgery, namely cervical laminoplasty or lumbar laminectomy. Methods: Seventy-two spine surgery patients were studied. A 16-row multidetector computed tomography was performed before and 3 d after the surgery. Patients with a history of cerebral vascular accident or arterial thrombotic episode or presurgical asymptomatic PE or DVT were excluded. Plasma levels of soluble fibrin monomer complex, D-dimer, plasminogen activator inhibitor type-1 (PAI-1), and white blood cell and platelet counts were measured preoperatively and postoperatively at days 1, 3, and 7. Results: No patient developed symptomatic post-surgical VTE. Six patients with asymptomatic PE and six with asymptomatic DVT were detected post-surgery, including one patient with both. D-dimer postoperatively at days 3 and 7 was significantly higher in the post-op PE group than in the no-PE group. PAI-1 preoperatively was significantly higher in the DVT and VTE groups than in the no-DVT and no-VTE groups. Conclusions: Elevated D-dimer at postoperative days 3 and 7 is a predictive factor for the early diagnosis of PE after spine surgery. Moreover, elevated PAI-1 preoperatively is a predictive factor for the early diagnosis of DVT and VTE. Consequently, PE may occur through a pathway other than DVT.

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