Fatal extensive bone cement embolism: Histological findings confirmed by Fourier transform infrared spectroscopy

Zheng, Na; Liang, Man; Zhang, Haidong; Zhu, Shao Hua; Tian, Yang; Zhuo, Luo; Wang, Gui Feng; Liu, Hong Xia; Liu, Liang

doi:10.1016/j.forsciint.2013.03.031

Cited by 9 publications

(13 citation statements)

References 8 publications

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“…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 ].…”

Section: Discussionmentioning

confidence: 99%

“…[ 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 ]. Of the 13 cases, one had a fatal outcome, and two required open embolectomy; Where pulmonary cement embolisms involve main arterial trunks or are located in cardiac cavities but the patient is asymptomatic, anticoagulation is recommended for 6 months.…”

Section: Discussionmentioning

confidence: 99%

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Pulmonary cement embolism following transpedicular screws placement for thoracolumbar fractures

Gomez¹,

Herrera²,

Gaona³

et al. 2021

Surgical Neurology International

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Background: Symptomatic pulmonary cement embolism in patients undergoing thoracic transpedicular fenestrated screw placement is rare. Here, we have added a 64-year-old female undergoing transpedicular screw placement for a T11 fracture who developed a pulmonary cement embolism intraoperatively and add this case to 13 others identified in the literature. Case Description: A 64-year-old female presented with a type “C”, ASIA “E” T11 fracture. The thoracolumbar pedicle screw fixation was supplemented with bone cement due to her underlying severe osteoporosis. During the fluoroscopy-guided supplementation with bone cement, a leak through the paravertebral venous system was noted. Thirty minutes later, the patient acutely developed extreme respiratory failure and required mechanical ventilation for the next 2 days. The diagnosis of pulmonary embolism due to bone cement was confirmed on a contrast computed tomography study of the chest. Conclusion: Symptomatic pulmonary cement embolization supplementing transpedicular screws placement for osteoporotic bone is rare. Here, we present a 64-year-old female who during transpedicular fixation of a T11 fracture developed an acute pulmonary embolism from the bone cement resulting in the need for 2 days of postoperative artificial ventilation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pulmonary cement embolism following transpedicular screws placement for thoracolumbar fractures

Gomez¹,

Herrera²,

Gaona³

et al. 2021

Surgical Neurology International

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“…In other cases, emboli infusion (such as calculi deposition) may provoke an inflammatory response by cytokine release and increasing vascular permeability that induces cardiovascular failure as acute respiratory distress syndrome and fall of blood pressure. 11 If a large amount of calcium emboli were combined with insufficient depth of anesthesia, pulmonary vagal nerve can be probably stimulated which would induce a strong vagal reflex manifested as severe arrhythmia, acute decrease in cardiac output and cardiac arrest, and even death, which has a higher incidence in the ages. Therefore, typical symptoms of grave acute pulmonary calculi embolism probably include shock, low blood oxygenation, and low pulmonary arterial pressure, with subsequent cardiac arrest.…”

Section: Discussionmentioning

confidence: 99%

Massive Pulmonary Calculi Embolism

Zhang

Zhou

2015

Medicine

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Pneumatic lithotripsy is a minimally invasive technique mainly for the treatment of urinary staghorn stones. Previous literatures have reported some therapeutic complications during or after this procedure, but calculi embolism has not been mentioned before.We report here a fatal case of calculi-induced pulmonary embolism in an adult woman who underwent pneumatic lithotripsy. An autopsy did not reveal any evidence of pulmonary embolism. However, light microscopy revealed noticeable presence of calculi in pulmonary arterioles and capillaries, as evidenced by environmental scanning electron microscope and energy dispersive X-ray analysis. The primary determinants of calculi embolism include intrarenal pressure, and volume and viscosity of the calculi fragments formation. Vascular intravasation of smashed calculi might increase pulmonary vascular resistance and hypoxemia and decrease cardiac output.This case report intends to provide information for clinicians to consider the probability of intraoperative calculi embolism during lithotripsies when patients develop typical symptoms of acute pulmonary embolism.

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“…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.…”

Section: Introductionmentioning

confidence: 99%

“…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 ].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2023

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Fixation using cement-augmented pedicle screws (CAPS) is being increasingly performed. However, CAPS-associated cement leakage is a critical problem that can lead to cardiopulmonary cement embolism (CPCE). This narrative review aimed to explore the incidence of and risk factors and treatment strategies for CPCE and cement leakage-related complications after CAPS fixation. Data were extracted from each article, including characteristics of CPCE after CAPS fixation (incidence, location, diagnostic method and criteria, treatment, and outcome and prognosis). Overall, 28 case series and 14 case reports that met the inclusion criteria were included. Of the 1974 cases included in the review, CPCE was noted in 123, symptomatic CPCE in 35, and death in six, respectively. The frequencies of PCE and symptomatic PCE after CAPS fixation were 6% (range: 0–28.6%) and 1.3% (range: 0–26%), respectively. The range of frequencies of PCE and symptomatic PCE after CAPS fixation may have been wide because the definition of CPCE and data collection methods differed among the reports analyzed. Since PCE due to large cement emboli may be primarily related to the surgical technique, improved technique, such as minimizing the number of CAPSs by injecting low-volume high-viscosity cement at low velocity and pressure, and careful observation of cement leakage during CAPS insertion may reduce PCE associated with cement leakage. Spinal surgeons should pay more attention to the occurrence of CPCE during and after CAPS insertion, which can cause serious complications in some patients.

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Fatal extensive bone cement embolism: Histological findings confirmed by Fourier transform infrared spectroscopy

Cited by 9 publications

References 8 publications

Pulmonary cement embolism following transpedicular screws placement for thoracolumbar fractures

Pulmonary cement embolism following transpedicular screws placement for thoracolumbar fractures

Massive Pulmonary Calculi Embolism

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

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