As the rate of elective spinal surgeries increases, there is a growing concern about the risks of venous thromboembolism (VTE) in this specific patient population. In the general patient population, the annual incidences of deep venous thrombosis (DVT) and pulmonary embolism (PE) are estimated to be 50 and 70 per 100,000, respectively (1). However, the incidence of postoperative thromboembolic disease is not as well defined after spine surgery (2). The rate of symptomatic thromboembolic disease is reported to occur in 0.3% to 2.5% (3) of elective spine surgery patients, and the rate of asymptomatic disease is thought to occur in up to 16%, depending on the detection method used (4). The literature is not specific for cervical spine surgery but typically includes all types of spinal surgery.

The occurrence of DVT is difficult to predict. Risk factors include smoking, use of oral contraceptives, malignancy, hypercoagulable states, upper abdominal/pelvic surgery, increased age, obesity, trauma, spinal cord injury (SCI), and history of previous thromboembolic disease. Increased age, intraoperative venous stasis, and postoperative immobility and convalescence place postoperative spine surgery patients at particular risk for developing DVT. However, routine screening is not recommended, as only a small percentage of DVTs are symptomatic (5).

DVT is not dangerous in itself; however, when it leads to PE, it is life-threatening. In about 20% of cases, the initial presentation of VTE is sudden death due to PE. Of those patients who suffer a massive PE, 70% die within the first hour of symptom onset (6). Thus, the best way to treat VTE is to prevent it. Prophylactic measures to prevent DVT include early ambulation, compression stockings (CS), sequential pneumatic compression devices, vena cava filters, and pharmacologic anticoagulation. The method of prophylaxis should be selected based on the individual patient and his or her specific risk factors.