Acute pulmonary embolism after spine surgery in lumbar spinal stenosis: A case report
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Abstract
Pulmonary embolism (PE) is a serious condition in orthopedic surgery. The incidence of PE is quite lowbut it is high risk for morbidity and mortality . The role of pharmacologic thomboprophylaxis remains controversial in spine surgery. Some trials reported acute pulmonary embolism in pre-operative thromboprophylaxis patients. Management including type of anticoagulants and time to treat with anticoagulant in pulmonary embolism after spine surgery vary and depend on opinion of physicians. A75- year- old Thai female presented with severe back pain and diagnosed as spinal cord stenosis L4-L5,with kyphotic deformity was admitted for laminectomy L4-L5,transforaminal lumbar interbody fusion L5-S1 and pedicular screw fixation ,T6-S1 except right side of T10 with ostectomy T10-T12 and repair dura L4-L5 and posterior fusion T6-L5. Postoperative day 3 patient developed sudden dypsnea and hypoxemia. Computer tomography pulmonary artery reveals filling defect occupying nearly entire anterior segmental branch of left upper lobe pulmonary artery and lateral basal segment of left lower lobe pulmonary artery, lateral basal segment and posterior basal segment of right lower lobepulmonary artery. Moderate tricuspic regurgitation and high right ventricular systolic pressure were detected by transthoracic echocardiography.The patient was diagnosed intermediate risk pulmonary embolism and treated with intravenous heparin under closed observation for bleeding tendency and subdural hematoma in spinal cord Dypsnea was improved gradually without active bleeding condition then heparin was switched to subcutaneous enoxaparin .Enoxaparin was stopped after INR more than 1.8 and warfarin was continued. The patient was discharged without serious complications.
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