Intracardiac Leakage of Cement During Kyphoplasty and Vertebroplasty: A Case Report

Abstract

Patient: Male, 28Final Diagnosis: Intracardial cortoss leakSymptoms: Back painMedication: —Clinical Procedure: KyphoplastySpecialty: Orthopedics and TraumatologyObjective:Diagnostic/therapeutic accidentsBackground:Intracardiac leakage of bone cement after kyphoplasty and vertebroplasty is a rare and life-threatening complication. Cortoss, which is an injectable, non-absorbable, polymer composite that is designed to mimic cortical bone, can be used instead of cement. Here, we present the case of a patient with right intra-cardiac Cortoss embolization.Case Report:A 28-year-old man known to have ulcerative colitis since the age of 15 and treated with corticosteroids for more than 4 years and with anti-immune drugs presented to our hospital complaining of back pain and decreased body height due to osteomalacia with failed conservative treatment. Kyphoplasty and vertebroplasty of the thoracic 10–12 and first lumbar vertebrae were done with any complications. Three months later, the patient underwent kyphoplasty and vertebroplasty of lumbar 2–5 vertebrae by injecting Cortoss instead of cement, which was complicated with paravertebral intravascular leakage. We stopped surgery and transferred him to the recovery room, where he had slight chest pain that resolved spontaneously without neurological deficit.Two days later he developed severe chest pain and chest X-ray showed a large white shadow at the right side of the heart and another 2 small shadows just lateral to it. Sudden deterioration of patient status necessitated an emergency echocardiogram, which showed pericardial tamponade and a perforated right ventricle. Aspiration of pericardial blood and emergency open heart surgery were done. He was discharged 4 days later and was followed up at an outpatient clinic.Conclusions:Cardiac embolism is a serious condition that can complicate vertebral kyphoplasty; it requires a high level of suspicion and immediate action, and may need open heart surgery to save the patient’s life.

A Retrospective Study of Percutaneous Balloon Kyphoplasty for the Treatment of Symptomatic Schmorl’s Nodes: 5-Year Results

“…It is likely that pain relief is obtained through stabilization of the intraosseous fracture by the PMMA cement. Another mechanism is that the injected PMMA cement causes thermal necrosis and chemotoxicity to the intraosseous nociceptors [ 16 , 27 ]. We propose the use of PKP over PVP as a therapeutic strategy in patients with symptomatic SNs because PKP has the advantage of reduced cement extravasation.…”

Cement-associated thrombotic embolism in the inferior vena cava and bilateral iliac veins after percutaneous vertebroplasty: a case report

“…However, lifethreatening complications have sporadically been reported. Audat et al 5 reported intracardiac leakage of cement during kyphoplasty and vertebroplasty, and the patient recovered with life-saving open heart surgery. Chen et al 6 reported combined extraforaminal and intradiscal cement leakage following PVP, and the patient's discomfort was relieved after decompression surgery.…”

“…Audat et al. 5 reported intracardiac leakage of cement during kyphoplasty and vertebroplasty, and the patient recovered with life-saving open heart surgery. Chen et al.…”

In Vitro and In Vivo Characterization of Premixed PMMA-CaP Composite Bone Cements

“…However, it was concluded that this material provides comparable efficacy and safety to PMMA augmentation . Other clinical studies have reported mixed results, with one particular case describing intracardiac Cortoss embolization, and another reporting effective augmentation using low volumes of the material . In a case study, Piazolla et al reportedly observed that calcium phosphate cements used in vertebroplasty procedures were shown to result in future vertebral recollapse …”