Pulmonary embolism (PE) due to deep vein thrombosis (DVT) remains the most serious complication in acute spinal cord injury (SCI). The incidence of PE has been reported as relatively low in Japan, however it can be lethal if it occurs. We experienced two similar cases of fatal PE after SCI. Case 1 was a 44-year-old male with BMI of 29.4. He was treated for schizophrenia on an out-patient basis. He attempted suicide by leaping from a height and suffered polytrauma including bursting fracture of the third lumbar vertebra, for which posterior lateral fixation of the spine was performed. Seventeen days after surgery, he fell into cardiopulmonary arrest due to suspected PE and died in spite of aggressive cardiopulmonary resuscitation. Case 2 was a 34-year-old male with BMI of 35.5. He had a very similar history of mental disorder, mechanisms of injury and surgical procedures as case 1. He suddenly collapsed on the 27th postoperative day and was diagnosed as massive PE by arteriography. Thrombolytic therapy and catheter-tip embolectomy were immediately performed without success. For these two ceses, anticoagulation was not instituted. There are several factors that predisposed these patients to PE; trauma, obesity and postsurgical status for spine fracture. Prevention of DVT is the key strategy against PE. Therefore, Preventive measures including routine use of anticoagulants or placement of filter devices for these high-risk group patients should be considered.
