Pulmonary Cement Embolization After Vertebroplasty Requiring Pulmonary Wedge Resection

Rothermich, Marcus A.; Buchowski, Jacob M.; Bumpass, David B.; Patterson, G. Alexander

doi:10.1007/s11999-014-3506-0

Cited by 50 publications

(34 citation statements)

References 44 publications

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“…[25,28–30] In our material no one patient, during the time of follow-up, did reveal any systemic complications. During follow-up 104 patients had X-ray study of lungs performed and in 2 of them small acrylic deposits were found.…”

Section: Discussionmentioning

confidence: 83%

Complications of percutaneous vertebroplasty

Saracen

Kotwica

2016

Medicine

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Percutaneous vertebroplasty (PVP) is a minimally invasive procedure widely used for the treatment of pain due to vertebral fractures of different origins—osteoporotic, traumatic, or neoplastic. PVP is minimally invasive, but the complications are not rare; however, they are in most cases not significant clinically. The most frequent is cement leakage, which can occur onto veins, paravertebral soft tissue, into the intervertebral disk, or to the spinal canal, affecting foraminal area or epidural space. We analyzed results of treatment and complications of vertebroplasty performed with the use of polimethylomethylacrylate cement (PMMA) on 1100 vertebrae, with a special regard to the severity of complication and eventual clinical manifestation. One thousand one hundred PVP were analyzed, performed in 616 patients. There were 468 (76%) women and 148 men (24%), 24 to 94-year old, mean age 68 years. From 1100 procedures, 794 treated osteporotic and 137 fractures due to malignant disease, 69 PVP were made in traumatic fractures. One hundred patients had painful vertebral hemangiomas. Seven hundred twenty-six (66%) lesions were in thoracic, and 374 (34%) in lumbar area. Results of treatment were assessed using 10 cm Visual Analogue Scale (VAS) 12 hours after surgery, 7 days, 30 days, and then each 6 months, up to 3 years. Before surgery all patients had significant pain 7 to 10 in VAS scale, mean 8.9 cm. Twelve hours after surgery 602 (97.7%) reported significant relief of pain, with mean VAS of 2,3 cm. Local complications occurred in 50% of osteoporotic, 34% of neoplastic, 16% of traumatic fractures, and 2% of vertebral hemangiomas. The most common was PMMA leakage into surrounding tissues—20%; paravertebral vein embolism—13%; intradiscal leakage—8%; and PMMA leakage into the spinal canal—0.8%. Results of treatment did not differ between patients with and without any complications. From 104 patients who had chest X-ray or CT study performed after surgery, pulmonary embolism was noted in 2 patients, but without any clinical symptoms. Only 1 patient—with PMMA leakage into the spinal canal required surgical decompression In conclusion, PVP is effective in decreasing the level of pain in compression vertebral fractures. Complications occur in almost half of the patients but in more than 95% of them do not produce any clinical symptoms.

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Section: Discussionmentioning

confidence: 83%

Complications of percutaneous vertebroplasty

Saracen

Kotwica

2016

Medicine

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“…The patient in this case underwent a surgical embolectomy. Rothermich et al (14), on the other hand, reported on a case in which a 29-year-old man whose right lower lung lobe had infarcted owing to massive cement embolization, who was subjected to an open pulmonary wedge resection and embolectomy. The patient recovered from the embolectomy, but suffered chronic, persistent respiratory symptoms after surgery.…”

Section: Discussionmentioning

confidence: 99%

A Rare Presentation of Pulmonary Embolism: Cement Embolism after Vertebroplasty

Tapan¹,

Tapan²,

Elibol³

2019

Respir Case Rep

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Vertebroplasty is a minimally invasive method for the treatment of painful vertebrae fractures. Cement embolism, as a rare complication of this method, is usually asymptomatic and does not require treatment. Anticoagulant therapy or surgical embolectomy is recommended when symptomatic. We present here a case of pulmonary cement embolism who presented with chest pain and shortness of breath 5 days after vertebroplasty for a thoracic vertebrae fracture, and who had undergone anticoagulant treatment.

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“…Due to respiratory failure thoracotomy with embolectomy and resection of the right lower lobe had been performed. Radical improvement was seen as a result of this treatment [9]. There are still no studies comparing the effectiveness of different treatment strategies.…”

Section: Review Of the Literaturementioning

confidence: 91%

Pulmonary cement embolism after percutaneous vertebroplasty. (RCD code: II-1C.0)

Gurba

Deręgowska

Terpin

et al. 2016

Journal of Rare Cardiovascular Diseases

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Pulmonary cement embolism is a relatively new medical issue. The cement used in orthopedics is not even mentioned in the 2014 European Society of Cardiology (ESC) guidelines on the diagnosis and management of acute pulmonary embolism, however it will be a more frequent occurrence as minimally-invasive orthopedic procedures become more commonplace. An 81-year-old female was admitted to the emergency room with syncope. She had reported similar episodes of loss of consciousness and mild dyspnea for a few years prior to hospital admission. In 2008 the patient had undergone percutaneous vertebroplasty due to vertebral compression fractures. Her chest radiograph revealed multiple calcifications along the pulmonary vessels. Pulmonary computed tomography angiography confirmed pulmonary cement embolism. The presence of coexisting thrombus in one of the branches of the pulmonary artery was also revealed. The patient was administered enoxaparin subcutaneously and discharged. After 3 weeks repeat echocardiography showed a slight reduction in the dimensions of the pulmonary artery and its branches. Our case demonstrates that pulmonary cement embolism after percutaneous vertebroplasty may coexist with thrombotic embolus. Screening chest radiography after procedures using medical cement should be considered. Long term anticoagulation seems to be appropriate after pulmonary cement embolism. JRCD 2016; 2 (8): 266-269

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Pulmonary Cement Embolization After Vertebroplasty Requiring Pulmonary Wedge Resection

Abstract: Pulmonary cement embolism is a potentially serious complication of vertebroplasty. If a patient has chest pain or respiratory difficulty after the procedure, chest radiography and possibly advanced chest imaging studies should be performed immediately.

Cited by 50 publications

References 44 publications

Complications of percutaneous vertebroplasty

Complications of percutaneous vertebroplasty

A Rare Presentation of Pulmonary Embolism: Cement Embolism after Vertebroplasty

Pulmonary cement embolism after percutaneous vertebroplasty. (RCD code: II-1C.0)

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