Does Cervical Spinal Cord Injury Induce a Higher Incidence of Complications after Prophylactic Greenfield Inferior Vena Cava Filter Usage?

Abstract

To determine whether acute cervical spine injury represents a risk factor for complications from prophylactic placement of current generation Greenfield inferior vena cava (IVC) filters. A retrospective chart review performed during a 7-year period identified 11 patients with acute cervical spinal cord injuries who underwent prophylactic Greenfield IVC filter insertion. Specific complications evaluated included symptomatic pulmonary embolism (PE), migration, filter base diameter changes, caval perforation, and thrombosis. The amount of migration and changes in filter base dimension were compared statistically with a control population of IVC filter patients (n = 16) without cervical spine injuries. Filter migration (> 10 mm) was the most common complication (46%). Migration usually is caudally directed (64%), may occur early (36% moved > 10 mm within a 30-day period), and is often asymptomatic. The prevalence of filter migration greater than 30 mm was 27%. The average amount of migration for the subpopulation under study was greater than that seen with the control population (P < .05). No statistically significant change in filter base size occurred. The study population also had rates of PE (9%-18%), caval perforation (9%), and IVC thrombus formation (18%) that were higher than the rates in historical controls. The majority of patients with these complications received vigorous pulmonary toilet (46%), including "quad coughs" or cardiopulmonary resuscitation (18%). Acute cervical spinal cord injury and the associated supportive care may be associated with an increased risk for caudal IVC filter migration, IVC perforation, caval thrombosis, and PE.