Pulmonary cement embolism after percutaneous vertebroplasty and transpedicular screw fixation with bone cement: potential risk factors

Abstract

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. Attempts of maximum filling of the vertebral body and inadequate assessment of intertrabecular space volume, as well as anomalous anastomoses between the major blood vessels may cause clinically significant massive pulmonary embolism. Venospondylography performed before vertebroplasty may reveal the features of venous drainage of the vertebral body, which are the risk factors for massive cement embolism.

Keywords

• pulmonary cement embolism
• vertebroplasty
• computed tomography
• transpedicular fixation