Cement Embolism following Vertebroplasty: a case report

Cement Embolism following Vertebroplasty: a case report

Authors

  • Carmine Siniscalchi Parma University Hospital
  • Enrico Epifani Radiology Unit, Diagnostic Department. Parma University Hospital. Parma, Italy
  • Manuela Basaglia Internal Medicine Unit, Department of Internal and Emergency Medicine. Parma University Hospital. Parma, Italy.

Keywords:

Cement Embolism, chest pain, vertebroplasty

Abstract

Vertebroplasty consists of injection under image guidance of a cement polymer, commonly polymethylmethacrylate, into the vertebral body to improved stability. Vertebroplasty is essentially safety. However whether vertebral compression or (micro)fractures occur during the procedure, the high vascularization and the anatomic network of the paravertebral and extradural venous plexuses, can facilitate migration of cement fragments into the systemic venous circulation. We described the case of cement pulmonary embolism in a 75-year-old-female after vertebloplasty. A chest CT scan showed a multiple and spontaneus hyperdensities suggesting cement pulmonary-emboli. There are different therapeutic approach depending of the clinical severity. For asymptomatic patients clinical surveillance or prophylactic LMWH. Active treatment has been suggested only for symptomatic cases.

References

1. Mathis J, Deramond H, Belkoff S. Percutaneous ty and Kyphoplasty (Second Edition) Springer 2006; pp 3-5. ISBN 0-387-29078-8
2. Tarsuslugil S, O’Hara R, Dunne N, et al. Development of calcium phosphate cement for the augmentation of traumatically fractured porcine specimens using vertebroplasty. J Biomech
3. Longo UG, Loppini M, Denaro L, Brandi ML, Maffulli N, Denaro V. The effectiveness and safety of vertebroplasty for osteoporotic vertebral compression fractures. A double blind, prospective, randomized, controlled study. Clin Cases Miner Bone Metab. 2010;7:109–13
4. Katsumi K, Hirano T, Watanabe K, et al. Surgical treatment for osteoporotic thoracolumbar vertebral collapse using vertebroplasty with posterior spinal fusion: a prospective multicenter study. Int Orthop. 2016;40:2309
5. Brodano GB, Amendola L, Martikos K, et al. Vertebroplasty: benefits are more than risks in selected and evidence-based informed patients. A retrospective study of 59 cases. Eur. Spine J. 2011;20:1265–71
6. Yeom JS, Kim WJ, Choy WS, Lee CK, Chang BS, Kang JW. Leakage of cement in percutaneous vertebroplasty for painful osteoporotic compression fractures. J Bone joint Surg Br. 2016;85:83–9
7. Eck JC, Nachtigall D, Humphreys SC, et al. Comparison of vertebroplasty and balloon kyphoplasty for treatment of vertebral compression fractures: a meta-analysis of the literature. Spine J 2008;8:488–97
8. Groen RJ, du Toit DF, Phillips FM, et al. Anatomical and pathological considerations in percutaneous vertebroplasty and kyphoplasty: a reappraisal of the vertebral venous system. Spine 2004;29:1465–71
9. Luetmer MT, Bartholmai BJ, Rad AE, et al. Asymptomatic and unrecognized cement pulmonary embolism commonly occurs with vertebroplasty. AJNR Am J Neuroradiol 2011;32:654–7
10. Yoo KY, Jeong SW, Yoon W, et al. Acute respiratory distress syndrome associated with pulmonary cement embolism following percutaneous vertebroplasty with polymethylmethacrylate. Spine 2004;29:E294–E297
11. Botía González CM, Hernández Sánchez L, Plasencia Martínez JM. Cement Pulmonary Embolism. Am J Med Sci 2017;353:507
12. MacTaggart JN, Pipinos II, Johanning JM, et al. Acrylic cement pulmonary embolus masquerading as an embolized central venous catheter fragment. J Vasc Surg 2006;43:180–3.
13. Tozzi P, Abdelmoumene Y, Corno AF, et al. Management of pulmonary embolism during acrylic vertebroplasty. Ann Thorac Surg 2002;74:1706–8.
14. Agko M, Nazzal M, Jamil T, et al. Prevention of cardiopulmonary embolization of polymethylmethacrylate cement fragment after kyphoplasty with insertion of inferior vena cava filter. J Vasc Surg 2010;51:210–3.

Downloads

Published

08-06-2022

How to Cite

1.
Siniscalchi C, Epifani E, Basaglia M. Cement Embolism following Vertebroplasty: a case report. Acta Biomed [Internet]. 2022 Jun. 8 [cited 2024 Jul. 13];93(S1):e2022116. Available from: https://mattioli1885journals.com/index.php/actabiomedica/article/view/9425