Pulmonary Cement Embolism Associated with Percutaneous Vertebroplasty or Kyphoplasty: A Systematic Review

Wang, Lijun; Yang, Huilin; Shi, Yuanxin; Jiang, Weimin; Chen, Liang

doi:10.1111/j.1757-7861.2012.00193.x

Cited by 121 publications

(71 citation statements)

References 74 publications

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“…Common local adverse effects include pain, bleeding and infections 7. Venous leaks from vertebroplasty are very common4 5 with Lim et al 7 quoting 24% venous leaks from total 73% leaks reported. Serious systemic complications include paraplegia, paradoxical cerebral embolism and renal artery infarction 7.…”

Section: Discussionmentioning

confidence: 99%

“…Serious systemic complications include paraplegia, paradoxical cerebral embolism and renal artery infarction 7. However, there have been only 51 reported cases of pulmonary embolism caused due to cement migration through IVC5 with varying incidence of 0.9–23% 1 6. Cement leaks into the IVC showed a statistically significant (p=0.03) correlation with cement pulmonary embolism 8.…”

Section: Discussionmentioning

confidence: 99%

“…However, there is extensive mention in literature4 5 self-resolving bone medullary fat migration into the pulmonary circulation, but this is also known to cause fatal complications9 albeit rarely. Recent studies1 6 have been reported a progressively increasing incidence of cement embolisation.…”

Section: Discussionmentioning

confidence: 99%

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A rare nidus for pulmonary thromboembolism after vertebroplasty

et al. 2013

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Percutaneous vertebroplasty is used to treat osteoporotic compression fractures and bone loss due to malignancy. The cement used can serve as a potential nidus for pulmonary thromboembolism (PTE). An 87-year-old woman with recent L2 vertebroplasty presented with abdominal pain and shortness of breath. Thoracoabdominal CT scan revealed extensive bilateral pulmonary emboli associated with a 9 cm cement fragment in the inferior vena cava (IVC) extending proximally from the level of the right superior renal vein, likely secondary to cement leak from the vertebral plexus into the IVC. She refused catheter extraction was managed conservatively. There are 51 reported cases of cement pulmonary embolism. IVC foreign bodies serving as a nidus for PTE have been reported with IVC filters with an incidence of 6.2%. This is the second reported case of vertebroplasty cement serving as a nidus for PTE. Treatment depends on time interval between the procedure and the symptom onset.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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A rare nidus for pulmonary thromboembolism after vertebroplasty

et al. 2013

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“…This complication occurs relatively often in vertebroplasties and kyphoplasties of the thoracic and lumbar spine, with rates ranging from 2.1% to 26%. 2,8,16,24,49,52 Embolization via the arterial circulation of the vertebral artery into the posterior brain circulation has been described in 1 case and led to cerebellar symptoms and lateral homonymous hemianopia after the vertebroplasty. Imaging in this case revealed an acute cerebellar and occipital infarction due to a cement embolism of the vertebral artery.…”

Section: Discussionmentioning

confidence: 99%

Cervical vertebroplasty for osteolytic metastases as a minimally invasive therapeutic option in oncological surgery: outcome in 14 cases

Stangenberg

Viezens²,

Eicker

et al. 2017

Neurosurgical Focus

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OBJECTIVEThe treatment of cervical spinal metastases represents a controversial issue regarding the type, extent, and invasiveness of interventions. In the lumbar and thoracic spine, kypho- and vertebroplasties have been established as minimally invasive procedures for patients with metastases to the vertebral bodies and without neurological deficit. These procedures show good results with respect to pain reduction and low complication rates. However, limited data are available for kypho- and vertebroplasties for cervical spinal metastases. In an effort to add to existing data, the authors here present a case series of 14 patients who were treated for osteolytic metastases of the cervical spine using vertebroplasty alone or in addition to another surgical procedure involving the cervical spine in a palliative setting to reduce pain and restore stability.METHODSFourteen patients consisting of 8 males and 6 females, with a mean age of 64.7 years (range 44–85 years), were treated with vertebroplasty at the authors’ clinic between January 2015 and November 2016. In total, 25 vertebrae were treated with vertebroplasty: 10 C-2, 5 C-3, 2 C-4, 2 C-5, 3 C-6, and 3 C-7. Two patients had an additional posterior stabilization and 5 patients an additional anterior stabilization. In 13 cases, the surgical approach was a modified Smith-Robinson approach; in 1 case, the cement was injected into the corpus axis from posteriorly. Patients with osteolytic defects of the posterior wall of the vertebral body did not undergo surgery, nor did patients with neurological deficits. Preoperatively, on the 2nd day after surgery, and at the follow-up, neck pain was rated using the visual analog scale (VAS).RESULTSTwelve patients were examined at follow-up (mean 9 months). Neck pain was rated as a mean of 6.0 (range 3–8) preoperatively, 2.9 on Day 2 after surgery (range 0–5), and 0.5 at the follow-up (range 0–4), according to the VAS. The mean Neck Disability Index at follow-up was 3.6% (range 0%–18%).CONCLUSIONSAnterior vertebroplasty of the cervical spine via an anterolateral approach represents a safe and minimally invasive procedure with a low complication rate and appears suitable for reducing pain and restoring stability in cases of cervical spinal metastases. Vertebroplasties can be combined with other anterior and posterior operations of the cervical spine and, in the axis vertebra, can be performed transpedicularly from posteriorly. Thus, in cases in which the posterior wall of the vertebral body is intact, vertebroplasty represents a less invasive alternative to vertebral replacement in oncological surgery. Prospective randomized trials with a longer follow-up period and a larger patient cohort are needed to confirm the encouraging results of this case series.

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“…1 Incidence estimates vary widely from 2% to 26%. 2 The management of asymptomatic pulmonary cement embolism remains uncertain; our decision was informed by an analysis of a case report by Krueger and colleagues that suggested anticoagulation treatment only for centrally distributed emboli.…”

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confidence: 99%

Asymptomatic pulmonary cement embolism

Chang

Huang

2017

CMAJ

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A 59-year-old man presented for follow-up of an abnormal chest radiograph (Figure 1A), which had been ordered as part of a routine health examination. One year prior, he had sustained a compression fracture and traumatic spondylolisthesis because of a car accident. Treatment included percutaneous vertebroplasty at L3 and pedicle screw augmentation at L5 and S1.The patient did not have fever, dyspnea, cough or hemoptysis. There was no tenderness in the chest wall, and breath sounds were normal bilaterally. Computed tomography of the chest showed multiple linear hyperdense foreign bodies at the pulmonary arteries bilaterally. Radiography of the lumbar spine showed previous vertebroplasty at L3 with cement migration via the ascending lumbar vein ( Figure 1B). Because of the extensive distribution of cement, we offered the patient anticoagulation treatment, which he agreed to, after a discussion of the uncertainties and possible complications of this treatment.Pulmonary cement embolism is a known complication of vertebroplasty.1 Bone cement may migrate into the vertebral venous plexus and from there, it can enter the thoracic, followed by the pulmonary, venous systems.1 Incidence estimates vary widely from 2% to 26%.2 The management of asymptomatic pulmonary cement embolism remains uncertain; our decision was informed by an analysis of a case report by Krueger and colleagues that suggested anticoagulation treatment only for centrally distributed emboli.3 In situations where there is limited, poor-quality evidence, as in this case, decision-making may be complex, variable and often dependent on the values and preferences of the patient.

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Pulmonary Cement Embolism Associated with Percutaneous Vertebroplasty or Kyphoplasty: A Systematic Review

Cited by 121 publications

References 74 publications

A rare nidus for pulmonary thromboembolism after vertebroplasty

A rare nidus for pulmonary thromboembolism after vertebroplasty

Cervical vertebroplasty for osteolytic metastases as a minimally invasive therapeutic option in oncological surgery: outcome in 14 cases

Asymptomatic pulmonary cement embolism

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