Deep venous thrombosis after spinal surgery.

Eighty-six consecutive patients undergoing spinal surgery were studied with preoperative and postoperative compression ultrasonography of the lower extremities to identify acute deep venous thrombosis. Compression stockings were the only method of prophylaxis. Postoperative deep venous thrombosis developed in five patients (6%). Serial ultrasound scanning revealed propagation of the thrombus proximal to the knee in one patient, who was the only patient to be anticoagulated. There were no statistically significant differences in the incidence of deep venous thrombosis compared to the type of procedure, age, sex, length of operation, or duration of bed rest. In conclusion, deep venous thrombosis distal to the inguinal ligament is unusual after spinal surgery. Given the potential complications of anticoagulation, we recommend only mechanical prophylaxis.

The rotator crescent and rotator cable: an anatomic description of the shoulder's "suspension bridge".

Twenty fresh frozen cadaver shoulders were dissected in order to study the rotator cable-crescent complex. The rotator crescent is a term that we have used to describe the thin, crescent-shaped sheet of rotator cuff comprising the distal portions of the supraspinatus and infraspinatus insertions. The crescent was found to be bounded on its proximal margin by a thick bundle of fibers that we have called the rotator cable. This cable-crescent configuration was found to consistently span the insertions of supraspinatus and infraspinatus tendons. The dimensions of the rotator cable and crescent were measured by a digital micrometer. The rotator cable was found to be a very substantial structure, averaging 2.59 times the thickness of the rotator crescent that it surrounded. This anatomic study supports the concepts of stress-shielding of the rotator crescent by the stout rotator cable and stress transfer by this loaded cable system.