Fifty-two patients presenting with multilevel osteoporotic compression fractures were randomized to receive a multilevel vertebroplasty procedure utilizing high viscosity or low viscosity bone cement, delivered through a 2.8mm diameter narrow cannula or 4.2mm diameter wide cannula, respectively. The outcome of interest was the risk of pulmonary cement embolism, as measured by pulmonary arterial pressure and d-dimer levels. Results revealed significantly lower pulmonary arterial pressure and d-dimer levels post-operation in the high viscosity group compared to the low viscosity group.