Intracardiac bone cement embolism as a complication of vertebroplasty: management strategy

Hatzantonis, Catherine; Czyż, Marcin; Pyzik, Renata; Boszczyk, Bronek M.

doi:10.1007/s00586-016-4695-x

Cited by 46 publications

(38 citation statements)

References 28 publications

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“…However, cement leakage into the paravertebral space or blood vessels constitutes a potentially severe complication of PVP and can result in neurological deficit [1] or even paralysis, and pulmonary [2] or heart embolism [3][4][5][6], which can be fatal.…”

Section: Introductionmentioning

confidence: 99%

Percutaneous vertebroplasty with high- versus low-viscosity bone cement for osteoporotic vertebral compression fractures

Mao

Zeng

Wang

et al. 2020

Preprint

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Background: There is no consensus on the best choice between high- and low-viscosity bone cement for percutaneous vertebroplasty (PVP). This study aimed to compare the clinical outcomes and leakage between three cements with different viscosities in treating osteoporotic vertebral compression fractures.Methods: This is a prospective study comparing patients who were treated with PVP: group A (n = 99, 107 vertebrae) with high-viscosity OSTEOPAL V cement, group B (n = 79, 100 vertebrae) with low-viscosity OSTEOPAL V cement, and group C (n = 88, 102 vertebrae) with low-viscosity Eurofix VTP cement. Postoperative pain severity was evaluated using the visual analog scale. Cement leakage was evaluated using radiography and computed tomography.Results: There was no significant difference in the incidence of cement leakage between the three groups (group A 20.6%, group B 24.2%, group C 20.6%, P = 0.767). All three groups showed significant reduction in postoperative pain scores but did not differ significantly in pain scores at postoperative 2 days (group A 2.01 ± 0.62, group B 2.15 ± 0.33, group C 1.92 ± 0.71, P = 0.646). During the 6 months after cement implantation, significantly less reduction in the fractured vertebral body height was noticed in group B and group C than in group A (group A 19.0%, group B 8.1%, group C 7.3%, P = 0.009).Conclusions: Low-viscosity cement has comparable incidence of leakage compared to high-viscosity cement in PVP for osteoporotic vertebral compression fractures. It also can better prevent postoperative loss of vertebral body height.

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Section: Introductionmentioning

confidence: 99%

Percutaneous vertebroplasty with high- versus low-viscosity bone cement for osteoporotic vertebral compression fractures

Mao

Zeng

Wang

et al. 2020

Preprint

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“…Both fenestrated screws and solid screws with cement-augmented has been proved effective to improve the pullout strength of screws and reduce the risk of fixation failure by biomechanical studies and clinical trials [14,15]. But CL remains a common complication of CAPSI, and the leakage rate is from 11.6% to 82.4% in bone cement-augmented pedicle screw fixation of the thoracolumbar spine [16,17], which may cause severe complications such as nerve injury, vascular damage, pulmonary embolism, cardiac embolism and anaphylactic shock [17,18]. Notably, a multilevel cementaugmented pedicle screw in osteoporotic bone is considered to lead to the high incidence of CL and cement-related complications.…”

Section: Introductionmentioning

confidence: 99%

The effect and potential risks of using cement-augmented pedicle screw instrumentation on multiple segment fixation in osteoporotic spine with lumbar degenerative diseases

Tang¹,

Guo²,

Guo³

et al. 2020

Preprint

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Background: Cement-augmented pedicle screw instrumentation (CAPSI) has been found to significantly increase the pedicle screws anchorage in the osteoporotic vertebral body, however, with the increase of augmented level and bone cement dose, the incidence of cement leakage (CL) or side complication of CAPSI also increased. But the effect and potential risks of CAPSI for osteoporotic lumbar degenerative diseases (LDD) have not been investigated in the cases of multiple segment fixation. The purpose of this study was to investigate potential complications of using cement-augmented screws for multilevel fixation (three or four levels) and the effectiveness of this method for treating LDD with low bone quality.Methods: Our clinical database was reviewed for osteoporotic patients who using CAPSI or conventional pedicle screw (CPS) for multilevel fixation (three or four levels) between February 2010 to February 2017. A total of 93 patients with multilevel LDD were divided into the CAPSI group (46 subjects) and the CPS group (47 subjects), including 75 cases for three levels (L2-L5 21 cases、L3-S1 54 cases), 18 cases for four levels (L1-L5 2 cases、L2-S1 16 cases), and the average follow-up was 33.72±18.78 months (range: 24-108). Relevant data were recorded, including age, gender, body mass index (BMI), bone mineral density (BMD), diagnosis, fusion methods, bone graft, fusion level, lumbosacral fixation, different patterns of S1 pedicle screw placement, operation time, blood loss, hospital stay, complications, CL, pulmonary cement embolism (PCE), screw loosening and nonunion patients. Besides, the visual analogue scale (VAS) and Oswestry disability index (ODI) at pre-operation, post-operation, and follow-up were also assessed.Results: In the CAPSI group, a total of 336 augmented screws were placed bilaterally, and the average injection dose of bone cement was 1.85±0.65 ml (range: 1-4). The CL was observed in 44 patients (95.65%) and 116 screws (34.52%). Three cemented screws (0.89%) and twenty-four S1 conventional screws (44.44%) were found loosening during the follow-up and the overall fusion rate was 93.47%. For perioperative complications, two patients (4.35%) experienced PCE, one patient augmented vertebral fracture and three patients (6.52%) wound infection. And in the CPS group, seventeen patients (36.17%) and thirty-three screws (8.46%) suffered loosening in cranial or caudal segments (seven cranial cases and twenty-six of caudal), four cases experienced nonunion, the fusion rate was 91.49% in total. The operation time and hospital stay were longer in CAPSI group, but with a lower percentage of screw loosening (P＜0. 05). And in terms of blood loss, perioperative complications, fusion rate, VAS and ODI scores at the follow-up times, no significant differences were found between the two groups.Conclusions: Patients with osteoporotic LDD underwent CPS at multiple segments have a high rate of screw loosening in the cranial and caudal segment. The application of cemented pedicle screws on multilevel LDD can achieve better stability and less screw loosening, but it also accompanied by longer operating time, higher incidence of CL, PCE and wound infections. Selective cement-augmenting the cranial and caudal pedicle screws may be a worthy strategy to decrease the complications.

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“…Both fenestrated screws and solid screws with cement-augmented has been proved effective to improve the pullout strength of screws and reduce the risk of fixation failure by biomechanical studies and clinical trials [14,15]. But CL remains a common complication of CAPSI, and the leakage rate is from 11.6-82.4% in bone cement-augmented pedicle screw fixation of the thoracolumbar spine [16,17], which may cause severe complications such as nerve injury, vascular damage, pulmonary embolism, cardiac embolism and anaphylactic shock [17,18]. Notably, a multilevel cementaugmented pedicle screw in osteoporotic bone is considered to lead to the high incidence of CL and cement-related complications.…”

Section: Introductionmentioning

confidence: 99%

The effect and potential risks of using cement-augmented pedicle screw instrumentation on multiple segment fixation in osteoporotic spine with lumbar degenerative diseases

Tang

Guo

Luo

et al. 2019

Preprint

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Intracardiac bone cement embolism as a complication of vertebroplasty: management strategy

Cited by 46 publications

References 28 publications

Percutaneous vertebroplasty with high- versus low-viscosity bone cement for osteoporotic vertebral compression fractures

Percutaneous vertebroplasty with high- versus low-viscosity bone cement for osteoporotic vertebral compression fractures

The effect and potential risks of using cement-augmented pedicle screw instrumentation on multiple segment fixation in osteoporotic spine with lumbar degenerative diseases

The effect and potential risks of using cement-augmented pedicle screw instrumentation on multiple segment fixation in osteoporotic spine with lumbar degenerative diseases

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