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J Neurosurg Spine. 2016 Dec;25(6):681-684. Epub 2016 Jul 22.

Venous air embolus during prone cervical spine fusion: case report.

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Departments of 1 Neurological Surgery and.
Department of Neurological Surgery, University of California, Irvine, Orange, California.
Seattle Science Foundation, Seattle, Washington.
Department of Anesthesia and Critical Care, The Methodist Hospital, Houston, Texas; and.
Anesthesia and Critical Care, Swedish Neuroscience Institute, Swedish Medical Center.


Venous air embolism (VAE) is a known neurosurgical complication classically and most frequently occurring in patients undergoing posterior cranial fossa or cervical spine surgery in a sitting or semi-sitting position. The authors present a case of VAE that occurred during posterior cervical spine surgery in a patient in the prone position, a rare intraoperative complication. The patient was a 65-year-old man who was undergoing a C1-2 fusion for a nonunion of a Type II dens fracture and developed a VAE. While VAE in the prone position is uncommon, it is a neurosurgical complication that may have significant clinical implications both intraoperatively and postoperatively. The aim of this review is 2-fold: 1) to improve the general knowledge of this complication among surgeons and anesthesiologists who may not otherwise suspect air embolism in patients positioned prone for posterior cervical spine operations, and 2) to formulate preventive measures as well as a plan for prompt diagnosis and treatment should this complication occur.


C1–2 fusion; CPR = cardiopulmonary resuscitation; TEE = transesophageal echocardiography; VAE = venous air embolism; prone cervical fusion; prone surgery; venous air embolus

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