Cement pulmonary embolism after balloon kyphoplasty

Idiculla, Pretty Sara; Rajdev, Kartikeya; Pervaiz, Sami; Cinelli, M; Habib, Saad; Siddiqui, Abdul Hasan; Ahmed, Sara

doi:10.1016/j.rmcr.2019.100887

Cited by 3 publications

(2 citation statements)

References 12 publications

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“…Known mechanisms that increase the risk for cement embolisms are high injection pressure of PMMA, high amount of PMMA used during a procedure, conduction of multiple vertebroplasties, thoracal vertebroplasties, and an insufficient fluidity management of PMMA. 6 An insufficient fluidity management during procedure leads to injection of PMMA, which is not yet crystalized and still too fluid. A too liquid texture is able to drain into the vertebral vein system, where the final crystallization finally takes place and is able to lead to the here described complications.…”

Section: Discussionmentioning

confidence: 99%

Massive cardiopulmonary cement embolism with cardiac perforation after vertebroplasty: a case series

Schoechlin

Schröfel

Czerny

et al. 2022

European Heart Journal - Case Reports

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Background The prevalence of cement embolism after percutaneous vertebroplasty ranges from 2.1%-26%, in literature. Even if most cases remain asymptomatic, intracardiac cement embolism becomes symptomatic in up to 8.3% of the cases. Case Summary We report a case series of two cases with massive cardiopulmonary cement embolism, which lead to perforation of the right ventricle and needed cardiothoracic surgery. Discussion As this entity affects different fields of medical specialties, and may lead to fatal outcome, we believe that the efforts of better understanding its development, avoidance, detection and treatment need to be intensified. For this purpose, systematic and interdisciplinary studies to follow up patients after vertebroplasty are needed.

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Section: Discussionmentioning

confidence: 99%

Massive cardiopulmonary cement embolism with cardiac perforation after vertebroplasty: a case series

Schoechlin

Schröfel

Czerny

et al. 2022

European Heart Journal - Case Reports

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“…Most areas where bone cement injection is performed alone are often flat bones rather than long bones, and typical areas include the spine and pelvis. 5 6 11 12) Although several studies have investigated pulmonary embolism and enhancement of intraosseous pressure (IOP) during vertebroplasty or kyphoplasty of the spine, 13 14 15 16 17 18 19) few studies have evaluated the IOP during percutaneous bone cement injection on the pelvis. Each vertebra has only two anatomical routes for accessing the vertebral body for bone cement injection, and these are the pedicles.…”

mentioning

confidence: 99%

Evaluation of Intraosseous Pressure during Pelvic Percutaneous Cement Injection: An In Vitro Study in Swine

et al. 2022

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Background A minimally invasive procedure for symptomatic pelvic bone metastasis is a feasible option for advanced cancer patients, and bone cement injection plays an essential role. Pulmonary embolism caused by thrombus, fat, or tumor emboli is a major complication related to bone cement injection, and increasing intraosseous pressure is a predisposing factor. This study aimed to quantify the degree of pressure change in the pelvic bone during percutaneous bone cement injection and investigate whether there is a significant decrease in intraosseous pressure when a decompressive route is additionally established. Methods Bone cement injection into the acetabulum of swine pelvises by simulating the actual surgical procedure in terms of the injection method, bone cement, and surgical instruments was performed while recording the intraosseous pressure. Twenty swine pelvises were used and grouped into a decompression group and a non-decompression group. Bone cement injection and pressure measurement were conducted in the same way in both groups, but an additional decompressive route was established for each pelvis in the decompression group. Continuous variables were compared using the Mann-Whitney test. Results The mean amount of injected bone cement was 19.8 mL and 20.3 mL and the mean speed of bone cement injection was 0.14 mL/sec and 0.12 mL/sec in the decompression group and the non-decompression group, respectively. The mean peak intraosseous pressures was 10.5 kPa with decompression and 37.8 kPa without decompression, and the difference was statistically significant ( p < 0.01). Conclusions Intraosseous pressure during bone cement injection into swine pelvises was similar to that during vertebroplasty or kyphoplasty. When the additional decompression route was established, the intraosseous pressure decreased to one third the level.

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Efficacy and Safety of Balloon Kyphoplasty for Pathological Vertebral Fractures in Patients with Hematological Malignancies in Our Institution

et al. 2021

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Objective Patients with hematological malignancies, particularly those with multiple myeloma, often suffer from pathological vertebral compression fractures (VCFs). Consequent and significant spinal pain and paralysis impair the activities of daily living and quality of life and delay subsequent chemotherapy. Balloon kyphoplasty (BKP), which is less invasive than conventional therapies, is a type of percutaneous vertebroplasty in which cement is injected into the broken vertebrae to stabilize the spinal column. The present study assessed the effect of BKP on hematological tumors. Methods We retrospectively analyzed five myeloma patients and one lymphoma patient who underwent BKP for pathological VCFs in our institution. Results The median age was 74 years old. The spinal operation level ranged from T2 to L4. BKP was performed at the diagnosis in two cases, after first-line chemotherapy in one case, and after subsequent chemotherapy in three cases. After approximately 1 month, the patients' average Eastern Cooperative Oncology Group performance status score rapidly improved from 3.2 to 1.3. The numeric rating scale score decreased from 8.8 to 2.0, and the Karnofsky Performance Status score increased from 35 to 75. No severe complications were observed. All patients became able to walk unassisted and underwent early subsequent chemotherapy. Conclusion BKP can be a safe and effective treatment option for pathological VCFs in patients with hematological malignancies and allows for rapid induction with subsequent chemotherapy.

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Cement pulmonary embolism after balloon kyphoplasty

Cited by 3 publications

References 12 publications

Massive cardiopulmonary cement embolism with cardiac perforation after vertebroplasty: a case series

Massive cardiopulmonary cement embolism with cardiac perforation after vertebroplasty: a case series

Evaluation of Intraosseous Pressure during Pelvic Percutaneous Cement Injection: An In Vitro Study in Swine

Efficacy and Safety of Balloon Kyphoplasty for Pathological Vertebral Fractures in Patients with Hematological Malignancies in Our Institution

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