• Naohisa Miyakoshi, Michio Hongo, Yuji Kasukawa, Yoshinori Ishikawa, Daisuke Kudo, and Yoichi Shimada.
• Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan. Electronic address: miyakosh@doc.med.akita-u.ac.jp.
• World Neurosurg. 2019 Nov 1; 131: 38-42.

BackgroundVenous air embolism (VAE) is a rare but, frequently, fatal complication that can occur during surgery. Several reported studies have shown visible bubbling of air at the surgical site as the first clinical indication of VAE-induced cardiovascular collapse during prone-position spine surgery. However, to the best of our knowledge, video imaging of this phenomenon has not been previously reported.Case DescriptionA 41-year-old man had undergone cervical laminoplasty for ossification of the posterior longitudinal ligament and thoracic laminectomy for ossification of the posterior longitudinal ligament and ossification of the ligamentum flavum in the prone position. The entire surgery was recorded with video imaging. Before cardiac arrest due to the massive VAE, visible air bubbling had been observed at the operated site of the thoracic laminectomy, and this phenomenon had been incidentally recorded with the video. The patient recovered with cardiopulmonary resuscitation and intensive treatment against severe acute respiratory distress syndrome due to pulmonary damage.ConclusionsThe present case report offers the first video imaging evidence of intraoperative visible air bubbling as a sign of a massive VAE during prone-position spine surgery. To the best of our knowledge, this is also the first report of intraoperative VAE in a patient with extensive ossification of the spinal ligaments.Copyright © 2019 Elsevier Inc. All rights reserved.

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