Pulmonary embolism with polymethyl methacrylate (bone cement) after percutaneous vertebroplasty (a review of literature and case reports)

Abstract

Percutaneous vertebroplasty (PVP) is a minimally invasive intervention widely used for relief of pain caused by osteoporotic, traumatic, or neoplastic vertebral fractures. During PVP, polymethyl methacrylate (bone cement) is injected directly into the vertebral body via a vertebral pedicle to partially restore the vertebral body height, to stabilize bone trabeculae and to alleviate pain. Though the procedure is minimally invasive, complications are not rare; however, mostly, they are not clinically significant. Potentially serious complications of PVP include pulmonary embolism with polymethyl methacrylate with variety of manifestations ranging from asymptomatic postoperative x-ray findings to life-threatening extravasation (cement "leakage") which is quite rare and fatal. Epidemiology, pathogenesis, clinical and radiological signs of pulmonary embolism in PVP and approaches to treatment are discussed in this review of literature. The article also describes two clinical cases of pulmonary embolism in patients underwent PVP for hemangioma of the vertebral body with severe pain syndrome are also described.