The patient,an 84-year-old man,was admitted to the hospital with"low back pain with limitation of movement for more than half a year".Admission examination:mild kyphotic deformity of the spine,significant tenderness and percussion pain in the lower back,bilateral lower limb muscle strength graded 5,normal skin sensation.Lumbar MRI and CT revealed a compressive fracture of the L4 vertebra.Dual-energy X-ray absorptiometry(DEXA)indicated a bone mineral density T-score of-2.6,suggesting os-teoporosis.Admission diagnosis:osteoporotic compressive fracture of the L4 vertebra.The patient underwent thorough examinations to exclude surgical contraindications.On the fourth day of admission,the patient underwent percutaneous vertebroplasty of the L4 verte-bra.At the end of the operation,the patient became unresponsive,with a blood pressure drop to 94/63 mmHg and oxygen saturation falling to 80％.Cranial CT showed multiple punctate gas density shadows within the brain.Lumbar CT revealed gas accumulation in the soft tissue adjacent to the lumbar spinous processes,localized intraductal gas,and punctate gas density shadows within the ves-sels in both groin areas.The diagnosis was intracranial arterial gas embolism.The patient's condition deteriorated further,with loss of consciousness,neck stiffness,increased muscle tone of both lower limbs,and positive Babinski's sign on both sides.Symptomatic treatments included brain protection,maintaining cerebral perfusion,and improving collateral cerebral circulation,but the patient did not regain consciousness.The patient developed a pulmonary infection one month postoperatively and died three months postopera-tively due to respiratory failure.This case highlights the potential risk of gas embolism during vertebroplasty.Measures to reduce such complications should be implemented,such as minimizing the duration of venous blood-air contact,pre-filling the cannula with saline to reduce the venous blood-air interface,and appropriately increasing venous pressure to reduce the risk of gas entry.It is rec-ommended to use smaller diameter catheters.For patients with pre-existing cardiac conditions or elderly patients,preoperative cardi-ac Doppler ultrasound should be performed to exclude anatomical abnormalities such as patent foramen ovale.
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