Objective To present one case of acute pulmonary embolism with deep venous thrombosis after posterior lumbar interbody fusion. Methods A 65-year-old female with severe left leg and low back pain ( VAS score 7 ) for 2 years was hospitalized. Left straight leg raising test result and Lasegue sign were positive. MRI revealed L4-5herniation with nerve root compression. The left-side was more severe. The patient underwent L4-5single-level posterior lumbar interbody fusion ( PLIF ) to relieve symptoms. Results The patient got sudden severe dyspnea and chest pain especially lying on the left side on the fifth day after the surgery. CTPA + CTV revealed acute pulmonary embolism with deep venous thrombosis. Then the patient was given Nadroparin calcium 0.7ml every 12 hours subcutaneously. Nadroparin calcium injection was stopped 10 days postoperatively when the patient felt much better without any dyspnea or chest pain. The patient was discharged from the hospital after 1 week of grade-two nursing. CTPA and CTV were rechecked 31 days postoperatively. Thrombosis was not found. Conclusions The complication of pulmonary embolism with deep venous thrombosis after posterior lumbar interbody fusion was rare but fetal. The risk factors include high BMI, advanced age, long hospital stay, prolonged operative time, anterior and posterior surgery, and fusion levels over three.