Safety and efficacy of decompressed vertebroplasty in reducing pulmonary fat embolism: a proof-of-mechanism study in a sheep model.

Background: Percutaneous vertebroplasty (PV) is a minimally invasive procedure for vertebral compression fractures. However, elevated intravertebral pressure during bone cement injection may increase the risk of pulmonary fat embolism (PFE). To address this issue, a decompressed vertebroplasty technique is introduced by incorporating a contralateral aspiration to establish a pressure gradient inside the vertebral body to guide cement flow. Such a mechanism can facilitate the removal of fat droplets. This study, therefore, assesses the effect of decompression PV on pulmonary fat droplet burden to evaluate its preliminary proof-of-mechanism potential. Methods: Eight skeletally mature male Corriedale sheep ( Results: CT analysis demonstrated that lung tissues in group B had significantly fewer OsO₄-positive fat droplets than those in group A (p = .034). This difference occurred despite comparable cement distribution between groups (Group A: 0.59 ± 0.33 mL, Group B: 0.71 ± 0.45 mL, p = .42) and no significant difference in cement extravasation rates. Histopathological evaluation revealed no spinal cord damage. Conclusions: In a healthy ovine model, decompressed vertebroplasty demonstrated preliminary proof-of-mechanism potential in reducing histological pulmonary fat droplet burden under the applied negative pressure gradient. However, further studies are required to determine whether these surrogate findings translate into a reduction in clinically meaningful embolic events or confirmed procedural safety in a clinical setting.