Pulmonary Embolism Caused by Cement Leakage after Percutaneous Kyphoplasty: a Case Report

Liu, Fa-jing; Ren, Huajian; Shen, Yong; Ding, Wenyuan; Wang, Linfeng

doi:10.1111/os.12010

Cited by 11 publications

(3 citation statements)

References 12 publications

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“…Thus, the number of vertebrae treated per vertebroplasty should be as low as possible. It is suggested that no more than three vertebrae should be injected in a single procedure 19 . If vertebral venography identifies a direct approach from the needle tip to the venous system intra‐operatively, repositioning of the needle tip and pre‐injection gelfoam embolization may help avoid leakage 20 .…”

Section: Discussionmentioning

confidence: 99%

Cardiac Perforation Caused by Cement Embolism after Percutaneous Vertebroplasty: A Report of Two Cases

Zhang

Liu

2022

Orthopaedic Surgery

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Background Percutaneous vertebroplasty (PVP) is a minimally invasive surgical technique in which polymethyl methacrylate (PMMA) is injected into the weakened vertebral body to strengthen it. However, this procedure is associated with various complications, the most common being cement leakage. Cardiac perforation caused by cement escape into the venous system is another complication, which is rare but potentially life‐threatening even if not treated promptly. Case Presentation Here, we report two elderly patients who developed cardiac perforation caused by cement escape into veins following PVP. Both patients had a history of severe osteoporosis. On admission, they presented with lower back pain and limited movement. MRI revealed vertebral bodies compression fracture in both patients. Considering the advanced age of the patients, PVP was performed to avoid the risk of potential complications associated with nonoperative therapy. Unfortunately, the rare and fatal postoperative complication, cardiac perforation caused by cement escape into veins, occurred in both patients. Emergency open‐heart surgery was performed to remove cement material and repair the heart, both patients recovered well and were discharged. Conclusions Although PVP is a safe and minimally invasive surgical technique, it is associated with various serious complications as seen in the present cases. We therefore recommend that surgeons should be aware of such complications. Appropriate timing of surgical operation, meticulous surgical procedures, early intraoperative and postoperative monitoring of cement leakage may improve outcomes of patients with such complications.

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Section: Discussionmentioning

confidence: 99%

Cardiac Perforation Caused by Cement Embolism after Percutaneous Vertebroplasty: A Report of Two Cases

Zhang

Liu

2022

Orthopaedic Surgery

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“…It is well known that bone cement leakage may occur in PVP and PKP treatment. The bone cement leakage may lead to pulmonary embolism [ 15 – 17 ], neurological deficit [ 18 ], and even paraplegia [ 19 ]. This work showed PMMA leakage occurred in 6.67% patients treated by PVP, 3.33% patients treated by PKP, and none of patients treated by PMCP ( Table 2 ).…”

Section: Discussionmentioning

confidence: 99%

Safety and Efficacy Studies of Vertebroplasty, Kyphoplasty, and Mesh-Container-Plasty for the Treatment of Vertebral Compression Fractures: Preliminary Report

Chen

Li²,

Wang

et al. 2016

PLoS ONE

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To evaluate the clinical safety and efficacies of percutaneous vertebroplasty (PVP), percutaneous kyphoplasty (PKP), and percutaneous mesh-container-plasty (PMCP) for the treatment of vertebral compression fractures (VCFs), a retrospective study of 90 patients with VCFs who had been treated by PVP (n = 30), PKP (n = 30), and PMCP (n = 30) was conducted. The clinical efficacies of these three treatments were evaluated by comparing their PMMA cement leakages, cement patterns, height restoration percentages, wedge angles, visual analogue scales (VAS), and oswestry disability index (ODI) at the pre- and post-operative time points. 6.67%, 3.33%, and 0% of patients had PMMA leakage in PVP, PKP, and PMCP groups, respectively. Three (solid, trabecular, and mixed patterns), two (solid and mixed patterns), and one (mixed patterns) types of cement patterns were observed in PVP, PKP, and PMCP groups, respectively. PKP and PMCP treatments had better height restoration ability than PVP treatment. PVP, PKP, and PMCP treatments had significant and similar ability in pain relief and functional recovery ability for the treatment of VCFs. These results indicate minimally invasive techniques were effective methods for the treatment of VCFs. Moreover, these initial outcomes suggest PMCP treatment may be better than both PVP treatment and PKP treatment.

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“…However, with the widespread use of these minimal invasive operations from inexperienced surgeons, catastrophic failures and even deaths are being encountered. Cement has been found literally from top to bottom in the human body, including spinal foramen/canal [ 13 , 32 , 35 ], perivertebral segmental vessels [ 75 ], vena cava [ 76 ], foot (dorsalis pedis artery), heart [ 77 , 78 ], and lungs [ 77 , 79 , 80 ]. Penetration of vital structures such as the aorta, pericardium (tamponade) [ 81 ], and lungs (pneumothorax) has been also encountered.…”

Section: Adverse Eventsmentioning

confidence: 99%

Controversial Issues in Kyphoplasty and Vertebroplasty in Osteoporotic Vertebral Fractures

Papanastassiou

Filis

Gerochristou

et al. 2014

BioMed Research International

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Kyphoplasty (KP) and vertebroplasty (VP) have been successfully employed for many years for the treatment of osteoporotic vertebral fractures. The purpose of this review is to resolve the controversial issues raised by the two randomized trials that claimed no difference between VP and SHAM procedure. In particular we compare nonsurgical management (NSM) and KP and VP, in terms of clinical parameters (pain, disability, quality of life, and new fractures), cost-effectiveness, radiological variables (kyphosis correction and vertebral height restoration), and VP versus KP for cement extravasation and complications profile. Cement types and optimal filling are analyzed and technological innovations are presented. Finally unipedicular/bipedicular techniques are compared. Conclusion. VP and KP are superior to NSM in clinical and radiological parameters and probably more cost-effective. KP is superior to VP in sagittal balance improvement and cement leaking. Complications are rare but serious adverse events have been described, so caution should be exerted. Unilateral procedures should be pursued whenever feasible. Upcoming randomized trials (CEEP, OSTEO-6, STIC-2, and VERTOS IV) will provide the missing link.

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Pulmonary Embolism Caused by Cement Leakage after Percutaneous Kyphoplasty: a Case Report

Cited by 11 publications

References 12 publications

Cardiac Perforation Caused by Cement Embolism after Percutaneous Vertebroplasty: A Report of Two Cases

Cardiac Perforation Caused by Cement Embolism after Percutaneous Vertebroplasty: A Report of Two Cases

Safety and Efficacy Studies of Vertebroplasty, Kyphoplasty, and Mesh-Container-Plasty for the Treatment of Vertebral Compression Fractures: Preliminary Report

Controversial Issues in Kyphoplasty and Vertebroplasty in Osteoporotic Vertebral Fractures

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