Open Access
Case Report

Spine surgery and fat embolism syndrome. Defining the boundaries of medical accountability by hospital autopsy

Davide Radaelli1,Martina Zanon1,Monica Concato1,Paolo Fattorini1,Letizia Alfieri2,Raffaella Marino2,Margherita Neri2,Luigi Cipolloni3,Stefano D’Errico1,*
Department of Medicine, Surgery and Health Sciences, University of Trieste, 34149 Trieste, Italy
Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy
Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy
DOI: 10.52586/5067 Volume 26 Issue 12, pp.1760-1768
Submited: 20 October 2021 Revised: 06 December 2021
Accepted: 08 December 2021 Published: 30 December 2021
*Corresponding Author(s):  
Stefano D’Errico
Copyright: © 2021 The author(s). Published by BRI. This is an open access article under the CC BY 4.0 license (

Background: Fat Embolism Syndrome (FES) is a clinical condition characterized by neurological, respiratory, hematological and cutaneous manifestations. Fatal FES has been described as a rare complication during or after spinal elective surgery. The investigation of the cause of death in fatalities related with spine surgery should be mandatory to exclude or confirm fat embolism; a detailed methodological approach to the body in these cases suggests to provide a cautious dissection of surgical site and collection of samples to detect embolized fat globules in vessels. Methods: Two fatal cases of fat embolism syndrome after posterior spinal fusion are presented. Conclusions: A complete post mortem examination by means of histochemical and immunohistochemical analysis explained the cause of death and prevented medical malpractice litigation.

Key words

Fat embolism syndrome; Spine surgery; Oil red; Immunohistochemistry; Autopsy; Liability; Claims; Accountability

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Davide Radaelli, Martina Zanon, Monica Concato, Paolo Fattorini, Letizia Alfieri, Raffaella Marino, Margherita Neri, Luigi Cipolloni, Stefano D’Errico. Spine surgery and fat embolism syndrome. Defining the boundaries of medical accountability by hospital autopsy. Frontiers in Bioscience-Landmark. 2021. 26(12); 1760-1768.