Case report: Cement entrapped in the inferior vena cava filter after pedicle screw augmentation

Abstract

BackgroundCement leakage into the inferior vena cava (IVC) is one of the most common complications associated with cement vertebroplasty, and can lead to potentially life-threatening complications such as pulmonary cement embolism (PCE). Implantation of an IVC filter is effective in the prevention of fatal pulmonary embolism. Here, we present an extremely rarely case of cement entrapped in an IVC filter after pedicle screw augmentation, and discuss all similar cases reported in the literature.Case presentationA 70-year-old female presented with significant back and lower extremities pain and was unable to walk. MRI of the lumbar spine revealed an osteoporotic compression fracture of the L1–L3. She underwent cement-augmented pedicle screws implanted at the L1 and L3 vertebral bodies. A retrievable IVC filter was implanted due to the presence of calf vein thrombosis before cement vertebroplasty. Cement leaked into the IVC and was trapped by the filter, rendering the filter unretrievable using a conventional method. The asymptomatic patient received rivaroxaban 20 mg daily for anticoagulant postoperatively and lifelong anticoagulation was administered to prevent secondary IVC and cemented filter thrombosis.MethodsA literature search was conducted utilizing the PUBMED/MEDLINE using the following terms: “vertebroplasty,” “complication,” “bone cement,” and “inferior vena cava (IVC),” or “inferior vena cava (IVC) filter.” All relevant articles published in English or in other languages with English abstracts since 1962 were included.ResultsA total of 36 articles were retrieved according to the search strategy. Only 6 out of these 36 studies contained information regarding the inferior vena cava filter and cement. Of the patients, 85.7% (36/42) reported in the literature whose gender was known were female and 14.3% were male. 28.5% (45/158) patients with pulmonary arterial and cardiovascular complications.ConclusionCement embolization occurring in the IVC filter is rare. Accurate knowledge about the lumbar vertebral venous anatomy and skillful operation during vertebral cementoplasty should be required in clinical practice.

Cardiopulmonary Cement Embolism Following Cement-Augmented Pedicle Screw Fixation: A Narrative Review

“…Although the number of studies (number of cases) reporting this issue are limited, this may be an anatomical note to keep in mind when performing CAPS. The relationship between the IVC and lumbar vein and characteristics of the lumbar vein need to be discerned, because intraoperative cement leakage into the IVC significantly contributes to PCE [ 68 ]. The lumbar veins enter the IVC at the L1-L5 vertebral positions, and cement flow into the IVC may result from the numerous connections to the vertebral and branch veins, lack of valves in the internal and external venous plexus, marked venous enlargement in older individuals, and lower pressure in the vertebral venous system than in the pelvic veins [ 34 , 68 , 69 ].…”

“…The relationship between the IVC and lumbar vein and characteristics of the lumbar vein need to be discerned, because intraoperative cement leakage into the IVC significantly contributes to PCE [ 68 ]. The lumbar veins enter the IVC at the L1-L5 vertebral positions, and cement flow into the IVC may result from the numerous connections to the vertebral and branch veins, lack of valves in the internal and external venous plexus, marked venous enlargement in older individuals, and lower pressure in the vertebral venous system than in the pelvic veins [ 34 , 68 , 69 ]. Iwanaga et al demonstrated that latex or air injections into the lumbar vertebral bodies drain specifically into the IVC and not internally into the vertebral venous plexus within the vertebral canal [ 70 ].…”