Pulmonary cement embolism following transpedicular screws placement for thoracolumbar fractures

Abstract

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.

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

“…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.…”

“…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 ]. …”

“…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 ].…”

“…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.…”

“…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 ].…”