Fatal Complications During Photodynamic Bone Stabilization: A Case Report

Mina G, Dhoon TQ, Rahimian R, et al.

Cureus. 2025;17(7):e88686. doi:10.7759/cureus.88686

This case report presents a rare and fatal complication during a photodynamic bone stabilization system (PBSS) procedure in a 68-year-old woman with metastatic sarcoma. Following balloon insufflation during the operation, the patient experienced sudden cardiopulmonary collapse due to presumed embolic debris—likely from bone marrow or tumor tissue—entering systemic circulation. Despite emergency measures including ECMO, the patient died five days later.

The case emphasizes the high risk of embolic events even in skeletal regions typically viewed as low risk (humerus, ilium), particularly in elderly patients with compromised cardiopulmonary reserve and metastatic disease. The authors propose a mechanism similar to fat embolism or bone cement implantation syndrome. They advocate for heightened vigilance, risk stratification, and intraoperative planning in similar patients.

The discussion outlines practical recommendations for high-risk patients undergoing PBSS, including preoperative echocardiography, TEE monitoring, early communication among care teams, and preparedness for ECMO. The authors call for further awareness of potentially fatal embolic complications associated with intramedullary pressurization in fragile oncology patients.

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Thank you to Cureus for publishing this valuable case report and for supporting open access to important surgical and anesthesia literature.