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Open spine stabilization with polymethylmethacrylate (PMMA) augmentation procedures requires significant attention during anesthetic management due to the complication of PMMA embolization. This chapter presents a case study of a 54-year-old male with a T12 burst fracture presented for a second stage posterior instrumentation of T9-L4. It presents a case of hemodynamic instability due to embolization during surgery as well as its management. Myocardial ischemia, pulmonary embolism (PE) from deep venous thrombosis or PMMA, and anaphylactoid/anaphylaxis reaction were considered. This patient had osteoporosis, a systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fractures. Cardiopulmonary presentation is either immediate or delayed and can be catastrophic. Consider a chest X-ray, echocardiogram, and computed tomography scan as diagnostic tools. If strongly symptomatic, consult cardiothoracic surgery for possible embolectomy.