Fang Tianci, Xue Zhifang, Yang Lianda, He Zhaohui, Yang Huilin, Liu Hao, Zhang Junxin, Zhou Feng
Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, China; Orthopaedic Institute, Medical College, Soochow University, Suzhou, China.
The Second Clinical Medical College, Xuzhou Medical University, Xuzhou, China.
World Neurosurg. 2025 Jul;199:124074. doi: 10.1016/j.wneu.2025.124074. Epub 2025 May 12.
Cerebral air embolism (CAE) is a rare but catastrophic complication of percutaneous kyphoplasty (PKP), with only 6 documented cases in spinal surgery literature. This study presents a novel case of CAE following PKP, resulting in a vegetative state despite hyperbaric oxygen therapy (HBOT), and synthesizes existing evidence to elucidate pathogenesis and propose prevention protocols.
A systematic literature review (PubMed/Embase, 2000-2023) identified all reported CAE cases after spinal surgery. We integrated a new case of PKP-induced CAE in an 84-year-old male with an L4 compression fracture. Data were analyzed to define mechanisms (anatomic pathways, procedural factors), diagnostic patterns, and management outcomes.
Among the 7 total cases (including ours), CAE manifested as acute neurological decline (coma, Babinski sign) within minutes postoperatively. Anatomical vulnerabilities (intravertebral vacuum clefts, posterior wall defects) and trocar-related air ingress were key pathogenic factors. All 3 patients receiving HBOT survived, but our case progressed to a vegetative state. Prevention strategies include preoperative computed tomography/magnetic resonance imaging screening for vertebral defects and cardiopulmonary shunts; intraoperative technical refinements (airtight trocar placement, temperature-modulated cement delivery); and postoperative vital/neurological monitoring.
CAE demands protocol-driven vigilance in PKP and analogous spinal procedures. Preoperative risk stratification, standardized intraoperative safeguards, and immediate HBOT initiation are critical to mitigate this complication. Our proposed multiphase protocol provides actionable guidelines for prevention and acute management.
脑空气栓塞（CAE）是经皮椎体后凸成形术（PKP）一种罕见但灾难性的并发症，脊柱外科文献中仅有6例记录在案。本研究报告了1例PKP术后发生CAE的新病例，尽管接受了高压氧治疗（HBOT），患者仍进入植物人状态，并综合现有证据阐明其发病机制，提出预防方案。
通过系统文献回顾（PubMed/Embase，2000 - 2023年）确定脊柱手术后所有报告的CAE病例。我们纳入了1例84岁男性L4压缩性骨折患者PKP术后发生CAE的新病例。对数据进行分析，以确定其机制（解剖途径、手术因素）、诊断模式和治疗结果。
在总共7例病例（包括我们的病例）中，CAE在术后数分钟内表现为急性神经功能衰退（昏迷、巴氏征）。解剖学薄弱环节（椎体内真空裂隙、后壁缺损）和与套管针相关的空气进入是关键致病因素。所有3例接受HBOT治疗的患者均存活，但我们的病例进展为植物人状态。预防策略包括术前计算机断层扫描/磁共振成像筛查椎体缺损和心肺分流；术中技术改进（密闭套管针放置、温度调节骨水泥注入）；以及术后生命体征/神经功能监测。
在PKP及类似脊柱手术中，CAE需要遵循方案进行警惕性监测。术前风险分层、标准化术中保障措施以及立即启动HBOT对于减轻这种并发症至关重要。我们提出的多阶段方案为预防和急性处理提供了可操作的指导方针。
