Acute deep venous thrombosis induced by May-Thurner syndrome after spondylolisthesis surgery: A case report and review of literature

Abstract

BACKGROUND

Deep venous thrombosis (DVT) is a serious complication of lumbar spine surgery. Current guidelines recommend pharmacomechanical prophylaxis for patients at high risk of DVT after spine surgery. May-Thurner syndrome (MTS), a venous anatomical variation that may require invasive intervention, is an often overlooked cause of DVT. To date, no case reports of symptomatic MTS caused by isthmic spondylolisthesis or subsequent acute DVT after posterior lumbar surgery have been published.

CASE SUMMARY

We here present a case of a patient who developed acute DVT 4 h after spondylolisthesis surgery, and MTS was only considered after surgery, during a review of a gynecological enhanced computed tomography image taken before the procedure.

CONCLUSION

In conclusion, clinicians should consider MTS in the presence of a dangerous triad: spondylolisthesis, elevated D-dimer levels, and sonographically indicated unilateral deep vein dilation. Consultation with a vascular surgeon is also essential to MTS management.

Keywords: Spondylolisthesis; Spine surgery; Deep venous thrombosis; May-Thurner syndrome; Complication; Case report

Core Tip: The overall prevalence of May-Thurner syndrome (MTS) and its contribution to deep venous thrombosis (DVT) are currently underestimated. We here present a case of acute DVT induced by MTS after lumbar surgery. MTS should be considered in the presence of a dangerous triad (spondylolisthesis, elevated D-dimer levels, and sonographically indicated unilateral deep vein dilation). Consultation with a vascular surgeon is essential to MTS management. A literature review of MTS in spinal settings was also performed.