A rare case of fatal pulmonary embolism immediately after scoliosis surgical correction

The incidence of pulmonary embolism in spinal surgery is very rare, especially when a posterior approach is adopted and the mechanisms of this complication in this type of surgery is not completely clear. In this population of patients, in light of the known risk of serious hemorrhagic complications (above all, subdural hematoma), there are no universally accepted guidelines on timing and methods of thrombo-prophylaxis; nowadays the prophylaxis, when considered, is mostly performed only in the post-operative phase. We describe a fatal case of a 59 years old man with no apparent previous risk factors in which the diagnosis of massive pulmonary embolism was made through autopsy and histopathological findings. The event arose immediately after spinal surgery carried out through the posterior approach. We believe that, although the high risk of bleeding in this type of surgery, some strategies of thrombo-prophylaxis should also be considered in the preoperative phase, since, as is illustrated by the case presented here, the embolism may arise suddenly and rapidly become fatal even in this low risk type of surgery.