Polymethylmethacrylate Pulmonary Embolism Following Vertebroplasty

Abstract

Polymethylmethacrylate (PMMA) is a commonly used substrate in vertebroplasty procedures. Well-known for its dependable strength and relative lack of toxic side effects, PMMA administration is useful for the stabilization of vertebral bodies in the setting of common spinal pathologies such as osteoporosis. Unfortunately, as the popularity of vertebroplasty has increased, so has the incidence of a potentially lethal complication of the procedure, PMMA pulmonary embolism. Extravasation of PMMA from the vertebral body into the adjacent vasculature can provide a route through which PMMA may travel until it becomes lodged in the pulmonary vasculature, thereby forming a PMMA pulmonary embolism. While the vast majority of PMMA embolism cases are relatively mild, others are severe and demand swift recognition and potentially life-saving intervention. Despite the increasing incidence of PMMA embolism, a clear algorithm for management does not yet exist. Controversy abounds regarding the most effective strategies to diagnose and manage patients with PMMA embolism. Described is a case of delayed diagnosis of a PMMA embolism in a patient who underwent percutaneous vertebroplasty for an osteoporotic vertebral body fracture. Multiple visits to the emergency department (ED) for chest discomfort or cough after the vertebroplasty eventually led to cross-sectional imaging that revealed the diagnosis. Her acute symptoms resolved with conservative management. Given that her final outcome was positive with no long-term morbidity, the aim of this report is to explore the current treatment algorithms for PMMA embolism and to consider whether or not this patient would have been managed differently had the correct diagnosis been uncovered earlier.

A composite of polymethylmethacrylate, hydroxyapatite, and β‐tricalcium phosphate for bone regeneration in an osteoporotic rat model

“…8 However, the use of PMMA in vertebroplasty has some drawbacks such as poor osseointegration with host bone, non-degradable behavior, and low biocompatibility. [9][10][11] In addition, a high polymerization temperature of PMMA has been discovered, which can damage adjacent cells. [11][12][13] Furthermore, due to its higher mechanical strength and elastic modulus, PMMA alone is not an optimal choice for engineering cancellous bone tissues.…”

“…Among them, polymethylmethacrylate (PMMA) has emerged as an excellent biomaterial to use as a bone cement in vertebroplasty 8 . However, the use of PMMA in vertebroplasty has some drawbacks such as poor osseointegration with host bone, non‐degradable behavior, and low biocompatibility 9–11 . In addition, a high polymerization temperature of PMMA has been discovered, which can damage adjacent cells 11–13 .…”

Acute abdomen after vertebroplasty-A rare complication

“…Most bone cement leaks are asymptomatic (2). In the past, several studies have reported serious complications of pulmonary embolism caused by bone cement leakage to the inferior vena cava (3). However, it is rare that bone cement leakage causes lesions in adjacent organs, and inexperienced doctors may overlook the association between these conditions and vertebroplasty.…”