Does Pre-Operative D-dimer Predict Deep Vein Thrombosis Risk in Patients with Spine Tumors?

Introduction: Deep vein thrombosis (DVT) is a common complication of spine surgery that can result in dangerous outcomes such as pulmonary embolism. Understanding DVT risk is essential to allow for preventative measures perioperatively. Patients with malignancy are at increased risk for DVT, however few studies have investigated risk factors for DVT in patients with spine tumors. This study aimed to assess the incidence of DVT in the spine tumor population and determine whether pre-operative D-dimer is associated with DVT risk.

Methods: Adult patients with spine tumors who had surgery at an academic institution between January 2021 and September 2024 were reviewed retrospectively. Incidence of perioperative DVT was assessed. D-dimer was compared between patients who developed DVT and those who did not. Age sex, tumor type, and spinal level of tumor were additional risk factors investigated. Differences between groups were assessed using the chi-square test for categorical variables and the t-test or Mann Whitney for continuous variables. Results are reported as mean with standard deviations.

Results: Of the 143 patients included in this study, 70.6% had spine metastases, 16.1% had intradural tumors, and 15.4% had primary bone tumors. DVT occurred in 5.9% of patients. Average D-dimer in patients who developed DVT (2100 +/- 2605) was higher than that of patients who did not develop DVT (1530 +/- 1943), however this difference was non-significant Age, sex, tumor type, and spinal level of tumor were also not significant predictors of DVT risk.

Conclusion : Among spine patients undergoing surgery, pre-operative D-dimer was not predictive of DVT risk. Most patients had elevated D-dimer levels whether or not they developed a DVT, which may reflect the hypercoagulable state induced by cancer at baseline. Therefore, D-dimer may not be a specific predictor of DVT risk in the spine tumor population.