Frequency and Outcome of Pulmonary Polymethylmethacrylate Embolism during Percutaneous Vertebroplasty

Venmans, A.; Lohle, Paul N.M.; Rooij, W.J. van; Verhaar, H.J.J.; Mali, Willem P.Th.M.

doi:10.3174/ajnr.a1269

Cited by 90 publications

(73 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A previous study showed that PCE occurred infrequently and caused no pulmonary reaction on CT after 1 year. 9 In our study, cement in the azygos vein on postprocedural CT of the treated vertebrae was the only risk factor for PCE. Analogously, other studies 13,14 showed a statistically significant relation between PCE and cement leakage into the inferior caval vein.…”

Section: Discussionmentioning

confidence: 45%

“…7,8 In most studies with a low incidence of PCE, "the occurrence of PCE" is defined as cement migration toward the lungs observed during fluoroscopy. 9 In studies with standard postprocedural chest radiographs, the observed incidence is higher 10,11 ; apparently, a substantial proportion of PCE remains undetected during fluoroscopy. In 1 study, the long-term effects of pulmonary cement deposits on the surrounding lung parenchyma are largely unknown.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Percutaneous Vertebroplasty and Pulmonary Cement Embolism: Results from VERTOS II

Venmans

Klazen²,

Lohle³

et al. 2010

AJNR Am J Neuroradiol

Self Cite

138

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 45%

mentioning

confidence: 99%

Percutaneous Vertebroplasty and Pulmonary Cement Embolism: Results from VERTOS II

Venmans

Klazen²,

Lohle³

et al. 2010

AJNR Am J Neuroradiol

Self Cite

138

View full text Add to dashboard Cite

show abstract

“…PMMA can leak through segmental veins into the inferior vena cava and reach the lungs. This is a well-known complication of vertebroplasty [15,16]; yet, alarming as it may seem, it is usually sub-clinical with very rare short-or long-term implications [15]. If routine chest CT scanning is done after the procedure, 23% of vertebroplasty patients are found to have pulmonary PMMA emboli [16], apparently with no sequelae.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous augmented instrumentation of unstable thoracolumbar burst fractures

et al. 2011

View full text Add to dashboard Cite

Background Internal fixation of unstable thoracolumbar spine fractures requires correction of the lacking anterior column support. This usually entails insertion of a vertebral body replacement strut through an anterior approach, or a long posterior construct spanning at least two vertebrae above and two vertebrae below the fracture. Posterior short-segment pedicle instrumentation (SSPI)-one vertebra above and below-is suitable for approximately 40% of fractures, but not for all. Methods A total of 52 patients with unstable thoracolumbar burst fractures meeting our inclusion criteria were instrumented using a novel approach, combining percutaneous SSPI, pedicle screw augmentation with polymethyl methacrylate (PMMA) and fractured vertebra kyphoplasty. We retrospectively reviewed patient and fracture data, operative results and 1 year radiographic follow-up postoperatively in 40 of the patients. We reviewed operative complications of all 52 patients. Results Most fractures were AO/Magerl type A3.1, A3.2 and A3.3. They were instrumented within 72 h and ambulated without additional external bracing. Operative time averaged 2 h and blood loss was less than 50 cc in most cases. Complications were mostly related to PMMA leakage. On average, 3.3°(0-13) of correction was lost after 3 months, but remained constant afterward. Conclusions Percutaneous augmented short-segment pedicle instrumentation of unstable thoracolumbar fractures can be done with short operative times, minimal blood loss and a low complication rate. The radiographical results at 1 year are equal to anterior stabilization and are better than other posterior-only techniques.

show abstract

“…The cement application, however, is comparable to its use in vertebroplasty and kyphoplasty, 49 and leakage rates might be comparable too. Cement leakage rates in vertebroplasty and kyphoplasty are reported to be between 19.3% 47 and 80%, 46 but they are usually above 40%. 9,22,24,32,36,44,48,49 The reason for high leakage rates in cadaver models might be the missing venous counter-pressure, 6 but this does not explain high leakage rates during surgery.…”

Section: 4%mentioning

confidence: 99%

Cement leakage in pedicle screw augmentation: a prospective analysis of 98 patients and 474 augmented pedicle screws

Mueller

Baldauf

Marx

et al. 2016

SPI

View full text Add to dashboard Cite

OBJECTIVE Loosening and pullout of pedicle screws are well-known problems in pedicle screw fixation surgery. Augmentation of pedicle screws with bone cement, first described as early as 1975, increases the pedicle-screw interface and pullout force in osteoporotic vertebrae. The aim of the present study was to identify cement leakage and pulmonary embolism rates in a large prospective single-center series of pedicle screw augmentations. METHODS All patients who underwent cement-augmented pedicle screw placement between May 2006 and October 2010 at the authors' institution were included in this prospective cohort study. Perivertebral cement leakage and pulmonary cement embolism were evaluated with a CT scan of the area of operation and with a radiograph of the chest, respectively. RESULTS A total of 98 patients underwent placement of cement-augmented pedicle screws; 474 augmented screws were inserted in 237 vertebrae. No symptomatic perivertebral cement leakage or symptomatic pulmonary cement embolism was observed, but asymptomatic perivertebral cement leakage was seen in 88 patients (93.6%) and in 165 augmented vertebrae (73.3%). Cement leakage most often occurred in the perivertebral venous system. Clinically asymptomatic pulmonary cement embolism was found in 4 patients (4.1%). CONCLUSIONS Perivertebral cement leakage often occurs in pedicle screw augmentation, but in most cases, it is clinically asymptomatic. Cement augmentation should be performed under continuous fluoroscopy to avoid high-volume leakage. Alternative strategies, such as use of expandable screws, should be examined in more detail for patients at high risk of screw loosening.

show abstract

Frequency and Outcome of Pulmonary Polymethylmethacrylate Embolism during Percutaneous Vertebroplasty

Cited by 90 publications

References 18 publications

Percutaneous Vertebroplasty and Pulmonary Cement Embolism: Results from VERTOS II

Percutaneous Vertebroplasty and Pulmonary Cement Embolism: Results from VERTOS II

Percutaneous augmented instrumentation of unstable thoracolumbar burst fractures

Cement leakage in pedicle screw augmentation: a prospective analysis of 98 patients and 474 augmented pedicle screws

Contact Info

Product

Resources

About