Percutaneous Endovascular Retrieval of Large Cement Leakage into the Right Atrium Following Cement-Augmented Pedicle Screw Instrumentation

Takahashi, Shinji; Sohgawa, Etsuji; Suzuki, Akinobu; Yamamoto, Akira; Sasaki, Ryo; Tanaka, Katsuaki; Terai, Hidetomi; Hoshino, Minoru; Toyoda, Hiromitsu; Tamai, Katsuto; Nakamura, Hiroaki

doi:10.22603/ssrr.2021-0011

Cited by 3 publications

(15 citation statements)

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“…Of the 14 case reports, conventional solid type screws were reported in seven studies [ 4 , 5 , 6 , 7 , 8 , 9 , 10 ], fenestrated screws in five [ 11 , 12 , 13 , 14 , 15 ], and the details were unknown in two [ 16 , 17 ] ( Table 2 ). In terms of reporting years, six of the seven case reports on conventional solid screws were reported between 2010 and 2013, while four of the five case reports regarding fenestrated screws were reported after 2020.…”

Section: Resultsmentioning

confidence: 99%

“…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 ]. …”

Section: Methodsmentioning

confidence: 99%

“…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 ].…”

Section: Methodsmentioning

confidence: 99%

“…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%

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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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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2023

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Comparison of the Fixation Strengths of Screws between the Traditional Trajectory and the Single and Double Endplate Penetrating Screw Trajectories Using Osteoporotic Vertebral Body Models Based on the Finite Element Method

Takeuchi,

Takamizawa,

Konishi

et al. 2024

Asian Spine J

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Study Design: This is a finite element (FE) study.Purpose: To compare the fixation strength of traditional trajectory (TT) and single and double endplate penetrating screw trajectories (SEPST/DEPST) to the osteoporotic vertebral body model based on the FE method.Overview of Literature: SEPST/DEPST have been developed to enhance the fixation strength in patients with diffuse idiopathic hyperostosis (DISH). This technique was also applied to patients with osteoporosis. However, determining the superiority of SEPST/ DEPST is difficult because of the heterogeneous patient backgrounds.Methods: Twenty vertebrae (T12 and L1) from 10 patients with osteoporosis (two males and eight females; mean age, 74.7 years) were obtained to create the 10 FE models. First, a single screw was placed with TT and SEPST/DEPST, and the fixation strength was compared by axial pullout strength (POS) and multidirectional loading tests. Second, two screws were placed on the bilateral pedicles with TT and SEPST/DEPST, and the fixation force of the vertebrae in the constructs in flexion, extension, lateral flexion, and axial rotation was examined.Results: SEPST and DEPST had 140% and 171% higher POS values than TT, respectively, and the DEPST result was statistically significant (p =0.007). The multidirectional fixation strength was significantly higher in DEPST and SEPST than in TT in the cranial, caudal, and medial directions (p <0.05) but not in the lateral direction (p =0.05). The vertebral fracture strength at the lower instrumented vertebra of the DEPST tended to be higher than that of TT. The vertebral motion angles in SEPST and DEPST were significantly smaller in lateral bending (p =0.02) and tended to be smaller in flexion and extension than in TT (p =0.13).Conclusions: This study may provide useful information for spine surgeons in deciding whether to choose the SEPS or DEPS technique for augmenting fixation in osteoporotic vertebral fracture surgery.

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Risk factors for pulmonary cement embolism after percutaneous vertebroplasty and radiofrequency ablation for spinal metastases

Wang

Zhang

et al. 2023

Front. Oncol.

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ObjectivePulmonary cement embolism is a rare but underestimated complication of vertebroplasty due to the relative lack of study and examination. This study aims to investigate the incidence of pulmonary cement embolism in patients with spinal metastasis who undergo PVP with RFA and to analyze the relative risk factors.MethodsA total of 47 patients were retrospectively included and classified into pulmonary cement embolism (PCE) group and non-pulmonary cement embolism (NPCE) group by comparing pre- and postoperative pulmonary CT scan images. The demographic and clinical information of the patients was obtained. Demographic data in the two groups were compared using the chi-square test for qualitative data and the unpaired t test for quantitative data. Multiple logistic regression analysis was used to identify risk factors related to pulmonary cement embolism.ResultsPulmonary cement embolism was detected in 11 patients (23.4%), and all patients were asymptomatic and followed up regularly. Risk analysis showed that multiple segments (≥3, p=0.022), thoracic vertebrae (p=0.0008), and unipedicular puncture approach (p=0.0059) were risk factors for pulmonary cement embolism. There was a high incidence of pulmonary cement embolism if bone cement leaked into the para vertebral venous plexus in the thoracic vertebra (p<0.0001). Vein leakage of cement was related to the integrity of the vertebral cortex.ConclusionThe number of involved vertebrae, lesion location, and puncture approach are independent risk factors for pulmonary cement embolism. There was a high incidence of pulmonary cement embolism if bone cement leaked into the para vertebral venous plexus in the thoracic vertebra. Surgeons should consider these factors when formulating therapeutic strategies.

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Percutaneous Endovascular Retrieval of Large Cement Leakage into the Right Atrium Following Cement-Augmented Pedicle Screw Instrumentation

Abstract: The authors declare that there are no relevant conflicts of interest.

Cited by 3 publications

References 6 publications

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

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

Comparison of the Fixation Strengths of Screws between the Traditional Trajectory and the Single and Double Endplate Penetrating Screw Trajectories Using Osteoporotic Vertebral Body Models Based on the Finite Element Method

Risk factors for pulmonary cement embolism after percutaneous vertebroplasty and radiofrequency ablation for spinal metastases

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