Pulmonary embolism after spinal surgery: report of two cases

We present two cases of pulmonary embolism (PE) without deep venous thrombosis (DVT) after spinal surgery with an anterior approach. On the seventh day after surgery, the patients’ plasma D-dimer levels were high without symptoms, so computed tomography (CT) was performed from chest to lower limb, revealing PE without lower limb DVT. After the exam, we immediately started anticoagulation therapy with heparin and warfarin. The patients were discharged with no complications. Previous reports have documented that DVT causes most cases of PE; however, our cases had no lower limb DVT. Some reports hypothesize that anterior spinal surgery might have a differential pathogenesis of PE. Simple mechanical prophylaxis for DVT may not protect these patients. On the other hand, the administration of chemical anticoagulants therapy after spinal surgery is controversial because of the risk of epidural hematoma. We should explain the risk of PE to patients undergoing spinal surgery with an anterior approach.