LAUSR

BACKGROUND Venous air embolism (VAE) is a rare but frequently fatal complication during surgery. Several published reports have shown visible bubbling of air at the surgical site as the first clinical indication of VAE-induced cardiovascular collapse in prone-positioned spine surgery. However, video imaging of this phenomenon has not been reported. CASE Description: A 41-year-old man underwent cervical laminoplasty for ossification of the posterior longitudinal ligament (OPLL) and thoracic laminectomy for OPLL and ossification of the ligamentum flavum (OLF) in the prone position. The entire surgery was recorded with video imaging. Prior to cardiac arrest due to massive VAE, visible air bubbling was observed at the operated site of thoracic laminectomy and this phenomenon was incidentally recorded with video. The patient recovered with cardiopulmonary resuscitation and intensive treatment against severe acute respiratory distress syndrome due to pulmonary damage. CONCLUSIONS This case report offers the first video imaging evidence of intraoperative visible air bubbling as a sign of massive VAE during prone-positioned spine surgery. This is also the first report of intraoperative VAE in a patient with extensive ossification of the spinal ligaments.