Fatal Pulmonary Fat Embolism Occurring in Lumbar Spinal Fusion Surgery: Case Report and Review of Literature
Journal: Journal of Clinical Medicine Research DOI: 10.32629/jcmr.v2i4.551
Abstract
Fat embolism system is one of the serious complications of orthopedic surgery, which is common seen in cases of severe trauma with long bone fractures. However, in clinical medical practice, it is rarely seen for Fat embolism system in orthopaedic lumbar fusion surgery. This paper report a case of sudden shock and death during lumbar fusion due to lumbar intervertebral disc disease. By forensic pathological examination, the pulmonary and brain fat embolism were observed in tissue sections, and the patient was diagnosed as FES. Based on the review of relevant literature and the pathological findings of this case, the clinical characteristics, diagnosis and treatment of FES in lumbar fusion are commentated in this paper. At the same time, it is emphasized that the clinical practise should strengthened the understanding and attention of non-traumatic fat embolism cases in order to timely identify, diagnose and treat the disease, improve the effectiveness of treatment, and reduce the corresponding medical disputes.
Keywords
lumbar spine, surgery, fat embolism, death, forensic pathology, judicial expertise
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[1]Milroy CM, Parai JL. Fat Embolism, Fat Embolism Syndrome and the Autopsy. Academic Forensic Pathology. 2019, 9(3-4): 136-154.
[2]J E Gittman, T A Buchanan, B J Fisher, P S Bergeson, P E Palmer. Fatal fat embolism after spinal fusion for scoliosis. JAMA. 1983, 249(6): 779-81.
[3]Brandt SE, Zeegers WS, Ceelen TL. Eur Spine J. Fatal pulmonary fat embolism after dorsal spinal fusion. European Spine Journal. 1998, 7(5): 426-8.
[4]Stroud MH, McCarthy RE, Parham DM, Schexnayder SM. Fatal pulmonary fat embolism following spinal fusion surgery. Pediatr Crit Care Med. 2006, 7(3): 263-6.
[5]Meng XL, Zhao H, Su QJ, Hai Y. Acute pulmonary embolism following adolescent idiopathic scoliosis correction surgery: case report and review of literature. J Int Med Res. 2013, 41(5): 1759-67.
[6]Michael H Stroud, Richard E McCarthy, David M Parham, Stephen M Schexnayder. Fatal pulmonary fat embolism following spinal fusion surgery. Pediatr Crit Care Med. 2006, 7(3): 263-6.
[7]Yoshimasa Takahashi, Ken'ichiro, Narusawa, Kenji Shimizu, Masakazu Takata. Fatal pulmonary fat embolism after posterior spinal fusion surgery. Journal of Orthopaedic Science. 2006, 11(2): 217-20.
[8]Zaihua Zhou, Jianye Liu. A case of fat embolism syndrome after lumbar tuberculosis surgery. China Journal of Orthopaedics and Traumatology. 2002, 15(10): 625.
[9]Christopher M. Milroy, Jacqueline L. Parai. Fat Embolism, Fat Embolism Syndrome and the Autopsy. Acad Forensic Pathol. 2019, 9(3-4): 136-154.
[10]Wang Huasong, Cai Xianhua, Liu Ximing et al. Clinical analysis of recurrence of fractures with fat embolism syndrome after internal fixation. Chinese Journal of Orthopaedic Trauma. 2013, 15 (6): 505-508.
[11]Li S, Zou D, Qin Z, et al. Nonfracture-associated pulmonary fat embolism after blunt force fatality: case report and review of the literature. Am J Forensic Med Pathol. 2015, 36(2): 61-66.
[12]Miller, Peter, Prahlow, Joseph A. Autopsy Diagnosis of Fat Embolism Syndrome. American J Forensic Med Pathol. 2011, 32 (3): 291-299.
[13]Lauren E Fukumoto, Kathryn D Fukumoto. Fat Embolism Syndrome. Nurs Clin North Am. 2018, 53(3): 335-347.
[14]Emine Turkmen Samdanci, Muhammet Reha Celik, Sultan Pehlivan, Osman Celbis, Dilhan Turkkan, Dogus Ozdemir Kara, Esra Pamukcu. Histopathological evaluation of autopsy cases with isolated pulmonary fat embolism (IPFE): is cardio -pulmonary resuscitation a main cause of death in IPFE? Open Access Emerg Med. 2019, 11: 121-127.
[15]Ondruschka B, Baier C, Bernhard M, Buschmann C, Dreßler J, Schlote J, Zwirner J, Hammer N. Frequency and intensity of pulmonary bone marrow and fat embolism due to manual or automated chest compressions during cardiopulmonary resuscitation. Forensic Sci Med Pathol. 2019, 15(1): 48-55.
[16]Chen Haofei, Sun Hong. A case of fat embolism syndrome caused by autologous blood transfusion during spinal surgery. Psychological Doctor. 2011, 9: 1339.
[17]Magnus Jacobsson, Anders Bengtsson. Fat embolism and autologous blood transfusions in orthopaedic surgery. Current Anaesthesia & Critical Care. 2004, 15(2): 87-93.
[18]David L. Rothberg, Christopher A. Makarewich. Fat embolism and fat embolism syndrome. J Am Acad Orthop Surg. 2019, 27(8): e346-e355.
[19]Gurd AR. Fat embolism: an aid to diagnosis. J Bone Joint Surg Br. 1970, 52: 732–737.
[20]Wang Yiceng, Meng Jimao, Guo Ziheng. Bone and joint Injury[M]. Beijing: People's Medical Publishing House, 1990: 241-247.
[21]Dou Guoyan, Fan Qinhe fan, et al. The relationship between traumatic death and pathological grade of pulmonary fat embolism in elderly patients. Practical Geriatrics. 2017, 31(7): 643-645.
[22]Timon C, Keady C, Murphy CG. Fat Embolism Syndrome — A Qualitative Review of its Incidence, Presentation, Pathogenesis and Management. Malaysian Orthopaedic Journal. 2021,15(1): 1-11.
[2]J E Gittman, T A Buchanan, B J Fisher, P S Bergeson, P E Palmer. Fatal fat embolism after spinal fusion for scoliosis. JAMA. 1983, 249(6): 779-81.
[3]Brandt SE, Zeegers WS, Ceelen TL. Eur Spine J. Fatal pulmonary fat embolism after dorsal spinal fusion. European Spine Journal. 1998, 7(5): 426-8.
[4]Stroud MH, McCarthy RE, Parham DM, Schexnayder SM. Fatal pulmonary fat embolism following spinal fusion surgery. Pediatr Crit Care Med. 2006, 7(3): 263-6.
[5]Meng XL, Zhao H, Su QJ, Hai Y. Acute pulmonary embolism following adolescent idiopathic scoliosis correction surgery: case report and review of literature. J Int Med Res. 2013, 41(5): 1759-67.
[6]Michael H Stroud, Richard E McCarthy, David M Parham, Stephen M Schexnayder. Fatal pulmonary fat embolism following spinal fusion surgery. Pediatr Crit Care Med. 2006, 7(3): 263-6.
[7]Yoshimasa Takahashi, Ken'ichiro, Narusawa, Kenji Shimizu, Masakazu Takata. Fatal pulmonary fat embolism after posterior spinal fusion surgery. Journal of Orthopaedic Science. 2006, 11(2): 217-20.
[8]Zaihua Zhou, Jianye Liu. A case of fat embolism syndrome after lumbar tuberculosis surgery. China Journal of Orthopaedics and Traumatology. 2002, 15(10): 625.
[9]Christopher M. Milroy, Jacqueline L. Parai. Fat Embolism, Fat Embolism Syndrome and the Autopsy. Acad Forensic Pathol. 2019, 9(3-4): 136-154.
[10]Wang Huasong, Cai Xianhua, Liu Ximing et al. Clinical analysis of recurrence of fractures with fat embolism syndrome after internal fixation. Chinese Journal of Orthopaedic Trauma. 2013, 15 (6): 505-508.
[11]Li S, Zou D, Qin Z, et al. Nonfracture-associated pulmonary fat embolism after blunt force fatality: case report and review of the literature. Am J Forensic Med Pathol. 2015, 36(2): 61-66.
[12]Miller, Peter, Prahlow, Joseph A. Autopsy Diagnosis of Fat Embolism Syndrome. American J Forensic Med Pathol. 2011, 32 (3): 291-299.
[13]Lauren E Fukumoto, Kathryn D Fukumoto. Fat Embolism Syndrome. Nurs Clin North Am. 2018, 53(3): 335-347.
[14]Emine Turkmen Samdanci, Muhammet Reha Celik, Sultan Pehlivan, Osman Celbis, Dilhan Turkkan, Dogus Ozdemir Kara, Esra Pamukcu. Histopathological evaluation of autopsy cases with isolated pulmonary fat embolism (IPFE): is cardio -pulmonary resuscitation a main cause of death in IPFE? Open Access Emerg Med. 2019, 11: 121-127.
[15]Ondruschka B, Baier C, Bernhard M, Buschmann C, Dreßler J, Schlote J, Zwirner J, Hammer N. Frequency and intensity of pulmonary bone marrow and fat embolism due to manual or automated chest compressions during cardiopulmonary resuscitation. Forensic Sci Med Pathol. 2019, 15(1): 48-55.
[16]Chen Haofei, Sun Hong. A case of fat embolism syndrome caused by autologous blood transfusion during spinal surgery. Psychological Doctor. 2011, 9: 1339.
[17]Magnus Jacobsson, Anders Bengtsson. Fat embolism and autologous blood transfusions in orthopaedic surgery. Current Anaesthesia & Critical Care. 2004, 15(2): 87-93.
[18]David L. Rothberg, Christopher A. Makarewich. Fat embolism and fat embolism syndrome. J Am Acad Orthop Surg. 2019, 27(8): e346-e355.
[19]Gurd AR. Fat embolism: an aid to diagnosis. J Bone Joint Surg Br. 1970, 52: 732–737.
[20]Wang Yiceng, Meng Jimao, Guo Ziheng. Bone and joint Injury[M]. Beijing: People's Medical Publishing House, 1990: 241-247.
[21]Dou Guoyan, Fan Qinhe fan, et al. The relationship between traumatic death and pathological grade of pulmonary fat embolism in elderly patients. Practical Geriatrics. 2017, 31(7): 643-645.
[22]Timon C, Keady C, Murphy CG. Fat Embolism Syndrome — A Qualitative Review of its Incidence, Presentation, Pathogenesis and Management. Malaysian Orthopaedic Journal. 2021,15(1): 1-11.
Copyright © 2021 Lu Zhang, Jie Zhang, Zihui Cheng, Lingjie Kong, Liang Wang, Long Yu, Songyue He
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