Clinical Study of Thromboembolism in Patients with Orthopedic Spinal Traumas

Abstract

Venous thromboembolism (VTE) remains a significant risk following spinal injuries, though its true incidence varies. In this retrospective study of 374 consecutive patients admitted to a comprehensive spinal care center, we assessed the incidence of clinical VTE, including deep vein thrombosis (DVT) and pulmonary embolism (PE), in both neurologically intact and spinal cord injury (SCI) patients. The majority of patients received non-surgical treatment and thromboprophylaxis initiated within a median 2 day post-injury. Among the neurologically intact groups, only one patient developed clinical PE (0.5%). However, 23 patients (14.5%) developed clinically evident VTE, with 15 (11.9%) diagnosed with DVT, 4 (5%) with PE, and 4 with both. Complete SCI lesions were associated with a significantly higher incidence of VTE (17.6%) compared to incomplete lesions (11%; p < 0.001). Two distinct peaks in thromboembolic events were observed: one in the first two weeks post-injury (30% of cases), and another after the 8th week following the discontinuation of thromboprophylaxis (38% of cases). These findings highlight the increased risk of VTE associated with more severe spinal cord injuries. While spinal column injuries in neurologically intact patients were associated with a lower risk, strict adherence to thromboprophylaxis protocols effectively reduced the incidence of VTE. We recommend that thromboprophylaxis continue for at least 12 weeks postinjury in SCI patients to mitigate the risk of VTE, especially in those with complete spinal cord lesions or other high-risk factors.