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Putative Risk of Substantial Venous Air Embolism During Vertebroplasty: A Technical Observation

White, J Bradley MD, PhD*; Thielen, Kent R. MD; Kallmes, David F. MD

doi: 10.1097/BRS.0b013e3181a90b44

Study Design. Technical report.

Objective. To convey the mechanism of venous air embolism (VAE) during percutaneous spinal procedures and its proper identification and management.

Summary of Background Data. Percutaneous spinal procedures such as vertebroplasty and kyphoplasty are commonplace techniques employed to alleviate back pain for compression fractures. VAE is a real and likely underappreciated phenomenon that is important to recognize.

Methods. A case report is used to illustrate the clinical scenario of VAE during vertebroplasty performed for a T9 compression fracture.

Results. The rapid sumping of fluid and air was identified during the procedure and believed to be due to a large air/venous interface within the trabecular bone. The needle was capped and no undue harm occurred to the patient.

Conclusion. VAE is a complication with associated morbidity and mortality from percutaneous procedures for the treatment of compression fractures. An understanding of the causes, prevention, identification, and management when it occurs will serve to improve patient care and reduce morbidity.

We describe a case of rapid sumping of fluid, and presumably air, into the vertebral body and likely into the venous system during vertebroplasty. We also offer a proposed mechanism for substantial venous air embolism during percutaneous spinal interventional procedures, in light of known mechanisms in other surgical procedures, and offer recommendations for how to avoid air embolism during vertebroplasty as well as other percutaneous needle based spinal interventional procedures.

From the *Department of Neuroscience and Experimental Therapeutics, Texas A&M University, College Station, TX; and †Department of Radiology, The Mayo Clinic, Rochester, MN.

Acknowledgment date: November 20, 2008. Revision date: February 19, 2009. Acceptance date: February 23, 2009.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to David F. Kallmes, MD, The Mayo Clinic, Department of Radiology, 200 First St. SW, Rochester, MN 55905; E-mail:

© 2009 Lippincott Williams & Wilkins, Inc.