Pulmonary Cement Embolism after Kyphoplasty

Abstract

An 80-year-old female with a history of osteoporosis was evaluated for sudden onset axial low back pain with bilateral lower extremity weakness, hyperreflexia, pain, urinary retention, and decreased rectal tone. Computed tomography of the lumbar spine revealed L1 compression fracture, retropulsion of bone causing spinal canal compromise with associated severe central canal stenosis. Following cement kyphoplasty of L1 with polymethyl methacrylate, the patient developed tachycardia and dyspnea. Chest radiograph and computed tomographic pulmonary angiogram revealed a large collection of hyperdense material within the right lower lobe pulmonary artery, consistent with pulmonary cement emboli. Management and imaging are discussed.

Tough and injectable fiber reinforced calcium phosphate cement as an alternative to polymethylmethacrylate cement for vertebral augmentation: a biomechanical study

“…26,45 Due to its low initial viscosity, PMMA cements easily invaded the pores of surrounding bone, thereby leading to extra-osseous leakage upon clinical usage. 2,5,46 This leakage was previously reported to cause serious complications such as pulmonary embolism, 47 nerve root compression 48 and even death. 49 Reported solutions to decrease such extra-osseous PMMA leakage mainly rely on increasing cement viscosity prior to injection.…”

Analysis of risk factors causing short-term cement leakages and long-term complications after percutaneous kyphoplasty for osteoporotic vertebral compression fractures

“…The complication rate of kyphoplasty is low, in the range of 1.6-3.8%, as reported by meta-analyses (12). However, sequelae derived from excessive cement leakage are harmful and can lead to paraplegia, intercostal neuralgia, pulmonary embolism, cardiac embolism and perforation, myocardial infarction, and even be life-threatening (13)(14)(15)(16)(17).…”

Analgesia from percutaneous thermal ablation plus cementoplasty for cancer bone metastases

“…There are observed difference in the risk between the heart and pulmonary in some study was significant. Despite the fact that the risk of intracardiac cement embolism is small (3.9%) and symptomatic complications are rare (0.3%) [49], the incidence of cement lung embolism is significantly higher, ranging from 2.1% to 75% [50], [51], [52]. In one survey, small cement emboli were found in approximately 10% of the patients, as identified by chest CT examination [53].…”