Pulmonary Cement Embolism during Cement Augmentation of Pedicle Screw Fixation: A Case Report

Akinola, Bolarinwa; Lutchman, L.; Barker, P; Rai, Am

doi:10.1177/230949901001800322

Cited by 13 publications

(19 citation statements)

References 6 publications

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“…However, as in most cases, it was clinically asymptomatic. 1,29,38,39 Due to the low sensitivity of conventional chest radiographs compared with CT scans, a much higher asymptomatic embolism rate must be assumed. 30 Studies of the rate of pulmonary embolism after percutaneous vertebroplasty have reported substantially different rates depending on the detection modality, with radiographs yielding a rate of 6.8%16 and CT yielding a rate of 23%.…”

Section: Symptomatic Leakage Is Rarementioning

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

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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.

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Section: Symptomatic Leakage Is Rarementioning

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

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“…По некоторым данным [10,15], ее частота варьиру-ет от 2,1 до 26,0 % выполненных опе-ративных вмешательств. В том числе описаны случаи цементной эмболии при выполнении транспедикулярной фиксации с установкой винтов на кост-ный цемент [1]. Чаще всего легочная цементная эмболия асимптоматич-на.…”

Section: Discussionunclassified

Pulmonary Cement Embolism After Percutaneous Vertebroplasty and Transpedicular Screw Fixation

Боков¹,

Млявых²,

Алейник³

et al. 2016

Hir. pozvonoč.

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Objective. To analyze cases of pulmonary cement embolism and to determine possible causes of the complication. Material and Methods.A heterogeneous group of 49 patients was retrospectively analyzed. Vertebroplasty was prescribed to the patients for restoration of vertebral support ability after osteoporotic compression fractures and hemangiomas, and as an auxiliary manipulation for transpedicular fixation of the osteoporotic spine. Thoracic computed tomography was performed and pulmonary cement embolism was revealed in the early or late postoperative periods.Results. Pulmonary cement embolism was revealed in 7 (14 %) patients, two of them presented with massive pulmonary cement embolism. In one case it was caused by excessive injection of cement, and in the other -by anomalous anastomosis. In one case, the vertebroplasty was cancelled taking into account the results of venospodilography. Conclusion

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“…Calcium phosphate augmentation also increases pull-out strength of pedicle screws; however, in head-to-head studies with PMMA, it has been shown to provide lower pull-out strength [33]. It is important to note that augmentation is not without its own risks, notably the risk of extravasation of cement into the spinal canal, neural foramens, or surrounding vascular structures when the cement or screw is inserted [34,35].…”

Section: Surgical Augmentationmentioning

confidence: 99%

Perioperative complications associated with spine surgery in patients with established spinal cord injury

Moghimi

Reitman

2016

The Spine Journal

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Pulmonary Cement Embolism during Cement Augmentation of Pedicle Screw Fixation: A Case Report

Cited by 13 publications

References 6 publications

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

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

Pulmonary Cement Embolism After Percutaneous Vertebroplasty and Transpedicular Screw Fixation

Perioperative complications associated with spine surgery in patients with established spinal cord injury

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