Symptomatic pulmonary cement embolism after pedicle screw polymethylmethacrylate cement augmentation: A case report and review

Abstract

Background: In osteoporotic patients, a useful technique for significantly enhancing the strength of a pedicle screw is augmentation with polymethylmethacrylate cement. However, a rare complication of this procedure is a symptomatic pulmonary cement embolism. Case Description: A pedicle screw cement augmentation was performed in a middle-aged female for the failed back syndrome. When she developed symptomatic pulmonary cement emboli, she was successfully managed with conservative measures, including anticoagulation. Conclusion: Despite the increased use of cement augmentation for pedicle screw placement and the relatively high incidence of cement leakage into the prevertebral venous system, symptomatic cement pulmonary embolism remains rare. The management of such symptomatic CPE should be evaluated and treated based on both the size and location of the embolism. Here, we presented this case while reviewing three symptomatic and four asymptomatic cases from the literature.

Pulmonary cement embolism following transpedicular screws placement for thoracolumbar fractures

“…Symptomatic pulmonary embolism due to bone cement utilized to perform transpedicular screw fixation is rare, occurring in 1.4% of isolated cases. [ 6 , 7 , 9 , 11 , 13 , 20 ] Currently, ten publications have reported 13 cases of patients with symptomatic pulmonary embolism due to bone cement. [ 1 , 5 , 9 - 12 , 14 - 16 , 20 ] Most of the patients reported were over 64 years of age and had instrumentation of the lumbar spine [ Table 1 ].…”

Cardiopulmonary Cement Embolism Following Cement-Augmented Pedicle Screw Fixation: A Narrative Review

“…Two major types of CAPS were found depending on the screw type: Conventional solid screws: cement-brushed solid screw inserted [ 19 ] or solid screw inserted after vertebroplasty [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 20 , 21 , 22 , 23 ]. Fenestrated screws ( Figure 1 ): these can be cemented after screw placement [ 11 , 12 , 13 , 14 , 15 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 ].…”

“…Conventional solid screws: cement-brushed solid screw inserted [ 19 ] or solid screw inserted after vertebroplasty [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 20 , 21 , 22 , 23 ].…”

“…However, while CAPS is being increasingly used, post-CAPS cement leakage is a considerable problem. Cement leakage into the spinal canal can cause spinal cord compression symptoms, including neurologic deficits and pain, while leakage into the epidural vein, vena cava, right atrium, pulmonary artery, or multiple lung arterioles can cause cardiac or pulmonary cement embolism (PCE) [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ]. Since both embolisms have the same pathology, this study included cardiopulmonary cement embolisms after CAPS as CPCE.…”

“…Heat associated with cement polymerization can also cause neurological damage [ 18 ]. However, only a few publications have reported the incidence of CPCE or CAPS-related complications, most in the form of case reports [ 2 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ]. CPCE rates reported in past studies showed a wide prevalence range because it does not have a standard definition, and different studies used different methods to evaluate cement embolism [ 2 ].…”