1
|
Liu X, Chu P, Miao Q. Case report: Open-heart removal for a cement embolism formed 10 years ago in the right ventricle and pulmonary artery. Front Cardiovasc Med 2023; 10:1221525. [PMID: 37534279 PMCID: PMC10390769 DOI: 10.3389/fcvm.2023.1221525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 07/03/2023] [Indexed: 08/04/2023] Open
Abstract
Bone cement embolism is a known complication after a kyphoplasty operation. Cement embolisms without immediate fatal complication such as cardiac perforation or hypoxemia were often stable during observation. We report a case of a large volume bone cement embolism involving the right ventricle and the pulmonary artery system. The patient developed mild exertional shortness of breath and chest pain after a percutaneous kyphoplasty (PKP) operation 10 years ago. However, her mild symptoms were attributed to multiple myeloma, and no chest imaging was taken until the symptoms exacerbated after a COVID-19 infection 6 months ago. A large, tree-branch-shaped embolus was found, causing severe obstruction of the ascending and middle-lobe branch of the right pulmonary artery. The pulmonary perfusion scintigraphy demonstrated an impaired perfusion of the right upper and middle lobe. An open-heart removal was performed, and the symptoms were relieved afterward. We report this case to highlight the importance of routine chest imaging after a PKP operation and to claim that open-heart removal for chronic cement pulmonary embolism is technically feasible and safe.
Collapse
|
2
|
Gao T, Chen ZY, Li T, Lin X, Hu HG, Wang XY, Zeng J, Wu C. The significance of the best puncture side bone cement/vertebral volume ratio to prevent paravertebral vein leakage of bone cement during vertebroplasty: a retrospective study. BMC Musculoskelet Disord 2023; 24:470. [PMID: 37291552 DOI: 10.1186/s12891-023-06580-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 05/30/2023] [Indexed: 06/10/2023] Open
Abstract
OBJECTIVES To verify the clinical significance of the best puncture-side bone cement/vertebral volume ratio (PSBCV/VV%) and bone cement leakage in paravertebral veins during vertebroplasty. METHODS This was a retrospective analysis of a total of 210 patients from September 2021 to December 2022, who were divided into an observation group (110 patients) and a control group (100 patients). In the observation group, patients' preoperative computed tomography (CT) data were imported into Mimics software, and the VV was calculated using the three-dimensional (3D) reconstruction function. Then, based on the best PSBCV/VV% of 13.68% determined in a previous study, the optimal PSBCV to be injected during vertebroplasty was calculated. In the control group, vertebroplasty was performed directly using the conventional method. The incidence of cement leakage into paravertebral veins was observed postoperatively in both groups. RESULTS There were no statistically significant differences (P > 0.05) in the evaluated indicators between the two groups pre- or postoperatively, including the anterior vertebral margin height, mid-vertebral height, injured vertebral Cobb angle, visual analogue scale (VAS) score, and Oswestry Disability Index (ODI). Intragroup comparisons showed improvements in the anterior vertebral height, mid-vertebral height, injured vertebral Cobb angle, VAS score, and ODI after surgery compared with before surgery (P < 0.05). In the observation group, there were 3 cases of cement leakage into the paravertebral veins, for a leakage rate of 2.7%. In the control group, there were 11 cases of cement leakage into the paravertebral veins, for a leakage rate of 11%. The difference in the leakage rate between the two groups was statistically significant (P = 0.016). CONCLUSION In vertebroplasty, preoperative VV calculations using Mimics software, combined with calculation of the PSBCV according to the best PSBCV/VV% (13.68%), can effectively prevent leakage of bone cement into paravertebral veins and further prevent serious life-threatening complications such as pulmonary embolism.
Collapse
Affiliation(s)
- Tao Gao
- Orthopaedics of Zigong Fourth People's Hospital, Zigong, 643000, Sichuan, China
| | - Zhi-Yu Chen
- Respiratory Medicine of Zigong Fourth People's Hospital, Zigong, 643000, Sichuan, China
| | - Tao Li
- Orthopaedics of Zigong Fourth People's Hospital, Zigong, 643000, Sichuan, China
| | - Xu Lin
- Orthopaedics of Zigong Fourth People's Hospital, Zigong, 643000, Sichuan, China.
| | - Hai-Gang Hu
- Orthopaedics of Zigong Fourth People's Hospital, Zigong, 643000, Sichuan, China
| | - Xiang-Yu Wang
- Orthopaedics of Zigong Fourth People's Hospital, Zigong, 643000, Sichuan, China
| | - Jun Zeng
- Orthopaedics of Zigong Fourth People's Hospital, Zigong, 643000, Sichuan, China
| | - Chao Wu
- Orthopaedics of Zigong Fourth People's Hospital, Zigong, 643000, Sichuan, China
| |
Collapse
|
3
|
Siniscalchi C, Epifani E, Basaglia M. Cement Embolism following Vertebroplasty: a case report. ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 93:e2022116. [PMID: 35674479 PMCID: PMC10510963 DOI: 10.23750/abm.v93is1.9425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 04/03/2020] [Indexed: 06/15/2023]
Abstract
Vertebroplasty consists of injection under image guidance of a cement polymer, commonly polymethylmethacrylate, into the vertebral body to improved stability. Vertebroplasty is essentially safety. However whether vertebral compression or (micro)fractures occur during the procedure, the high vascularization and the anatomic network of the paravertebral and extradural venous plexuses, can facilitate migration of cement fragments into the systemic venous circulation. We described the case of cement pulmonary embolism in a 75-year-old-female after vertebloplasty. A chest CT scan showed a multiple and spontaneus hyperdensities suggesting cement pulmonary-emboli. There are different therapeutic approach depending of the clinical severity. For asymptomatic patients clinical surveillance or prophylactic LMWH. Active treatment has been suggested only for symptomatic cases.
Collapse
Affiliation(s)
| | - Enrico Epifani
- Radiology Unit, Diagnostic Department. Parma University Hospital. Parma, Italy.
| | - Manuela Basaglia
- Internal Medicine Unit, Department of Internal and Emergency Medicine. Parma University Hospital. Parma, Italy..
| |
Collapse
|
4
|
Sun HB, Jing XS, Shan JL, Bao L, Wang DC, Tang H. Risk factors for pulmonary cement embolism associated with percutaneous vertebral augmentation: A systematic review and meta-analysis. Int J Surg 2022; 101:106632. [PMID: 35452848 DOI: 10.1016/j.ijsu.2022.106632] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Pulmonary cement embolism (PCE) was a rare but fatal complication for percutaneous vertebral augmentation (PVA). Thus we did a systematic review and meta-analysis of cohort studies to investigate the risk factors for PCE after PVA. METHODS We systematically searched PubMed, EMBASE, Cochrane library, Google Scholar, web of science, and ClinicalTrial.gov from the establishment of the database to September 2021. All eligible studies assessing the risk factors for PCE after PVA were incorporated. Dichotomous data was calculated by risk difference (RD) from Mantel-Haenszel method (M - H method); continuous data was analyzed by mean difference (MD) from Inverse-Variance method (I-V method). All variables were taken as measure of effect by fixed effect model. Heterogeneity, sensitivity, and publication bias analyses were also performed. RESULTS This study totally included 13 studies. According to the Newcastle-Ottawa Scale (NOS), 7 studies were considered as low quality, with NOS< 6. The others were of relatively high quality, with NOS≥6. 144/6251 patients (2.3%) had PCE after PVA. percutaneous vertebroplasty (PVP) (RD = 0.02, 95%CI: [0.01, 0.04], Z = 3.70, P < 0.01), thoracic vertebra (RD = 0.03, 95%CI: [0.01, 0.05], Z = 3.53, P < 0.01), higher cement volume injected per level (MD = 0.23, 95%CI: [0.05, 0.42], Z = 2.44, P = 0.01), more than three vertebrae treated per session (MD = -0.05, 95%CI: [-0.08, -0.02], Z = 3.65, P < 0.01), venous cement leakage (RD = 0.07, 95%CI: [0.03, 0.11], Z = 3.79, P < 0.01) were more likely to cause PCE. CONCLUSION This study showed that risk factors for PCE included PVP, thoracic vertebra, higher cement volume injected per level, more than three vertebrae treated per session, venous cement leakage. As a serious complication, PCE should be paid attention and avoided.
Collapse
Affiliation(s)
- Hai-Bo Sun
- Department of Orthopedics, Beijing Friendship Hospital Capital Medical University, No.95, Yong'an Road, Xicheng District, Beijing, 100050, China.
| | - Xiao-Shan Jing
- Department of Emergency, Beijing Friendship Hospital Capital Medical University, No.95, Yong'an Road, Xicheng District, Beijing, 100050, China.
| | - Jian-Lin Shan
- Department of Orthopedics, Beijing Friendship Hospital Capital Medical University, No.95, Yong'an Road, Xicheng District, Beijing, 100050, China.
| | - Li Bao
- Department of Orthopedics, Beijing Friendship Hospital Capital Medical University, No.95, Yong'an Road, Xicheng District, Beijing, 100050, China.
| | - De-Cheng Wang
- Department of Orthopedics, Beijing Tongzhou Hospital of Integrated Chinese and Western Medicine, CheZhanLu 89#, Tongzhou District, 101100, Beijing, 101100, China.
| | - Hai Tang
- Department of Orthopedics, Beijing Friendship Hospital Capital Medical University, No.95, Yong'an Road, Xicheng District, Beijing, 100050, China.
| |
Collapse
|
5
|
|
6
|
Gao T, Chen ZY, Li T, Lin X, Hu HG, Yuan DC, Zeng J, Wu C. Correlation analysis of the puncture-side bone cement/vertebral body volume ratio and bone cement leakage in the paravertebral vein in vertebroplasty. BMC Musculoskelet Disord 2022; 23:184. [PMID: 35219306 PMCID: PMC8882274 DOI: 10.1186/s12891-022-05135-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 02/14/2022] [Indexed: 12/29/2022] Open
Abstract
Objectives To explore the influencing factors of bone cement leakage in the paravertebral vein after vertebroplasty for the treatment of osteoporotic vertebral compression fractures (OVCFs) and to determine the correlation between the puncture-side bone cement/vertebral body volume ratio and bone cement leakage in the paravertebral vein. Methods This was a retrospective analysis of 495 patients (585 vertebral bodies) with OVCFs treated from August 2018 to May 2021 in our hospital. The patients’ postoperative CT data were imported into Mimics software, and the three-dimensional(3D) reconstruction function was used to calculate the bone cement volume (BCV), puncture-side bone cement volume (PSBCV), and vertebral body volume (VBV); the bone cement/vertebral body volume ratio (BCV/VCV%) and puncture-side bone cement/vertebral body volume ratio (PSBCV/VCV%) were additionally calculated. Sex, Age, Body mass index(BMI), Bone density, BCV, PSBCV, VBV, BCV/VCV%, and PSBCV/VCV were compared between the leakage group and the non-leakage group. Logistic regression analysis was used to assess the correlations between the factors that statistically significantly differed between the two groups and the presence of leakage in the paravertebral veins. A receiver operating characteristic (ROC) curve was used to determine the diagnostic value of the PSBCV/VCV% and to obtain the optional cut-off value. Results A total of 102 males and 393 females with an average age of 72.89 (52 ~ 93) years were included in our study. There were 57 cases of cement leakage (59 vertebral bodies) in the paravertebral vein. There were 438 patients (526 vertebral bodies) without paravertebral cement leakage. Univariate analysis showed that the differences in sex, bone density, PSBCV, and PSBCV/VCV% between the two groups were statistically significant (P < 0.05). Logistic regression analysis showed that there were correlations between sex, bone density, and PSBCV/VCV% and the presence of paravertebral cement leakage (P < 0.05). The ROC curve showed that the area under the curve of the PSBCV/VCV% for the diagnosis of cement leakage in the paravertebral vein was greater than 0.65, and P < 0.05, indicating a diagnostic value. The best cut-off point for the diagnosis of paravertebral cement leakage with the PSBCV/VCV% was 13.68%, with a sensitivity of 84.7% and specificity of 37.8%. Conclusion Sex, bone density, and PSBCV/VCV% are risk factors for cement leakage in the paravertebral veins after vertebroplasty for the treatment of OVCFs; the PSBCV/VCV% is strongly associated with paravertebral venous leakage, and the optimal PSBCV/VCV% is 13.68%. When the PSBCV/VCV% exceeds the optimal value, the risk of cement leakage in the paravertebral vein becomes significantly increased.
Collapse
|
7
|
Guo H, Huang H, Shao Y, Qin Q, Liang D, Zhang S, Tang Y. Risk Factors for Pulmonary Cement Embolism (PCE) After Polymethylmethacrylate Augmentation: Analysis of 32 PCE Cases. Neurospine 2022; 18:806-815. [PMID: 35000335 PMCID: PMC8752710 DOI: 10.14245/ns.2142616.308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 09/08/2021] [Indexed: 02/06/2023] Open
Abstract
Objective Pulmonary cement embolism (PCE) is an underestimated but potentially fatal complication after cement augmentation. Although the treatment and follow-up of PCE have been reported in the literature, the risk factors for PCE are so far less investigated. This study aims to identify the preoperative and intraoperative risk factors for the development of PCE.
Methods A total of 1,373 patients treated with the polymethylmethacrylate (PMMA) augmentation technique were retrospectively included. Patients with PCE were divided into vertebral augmentation group and screw augmentation group. Possible risk factors were collected as follows: age, sex, bone mineral density, body mass index, diagnosis, comorbidity, surgical procedure, type of screw, augmented level, number of augmented vertebrae, fracture severity, presence of intravertebral cleft, cement volume, marked leakage in the paravertebral venous plexus, and periods of surgery. Binary logistic regression analyses were used to analyze independent risk factors for PCE.
Results PCE was identified in 32 patients, with an incidence rate of 2.33% (32 of 1,373). For patients who had undergone vertebral augmentation, marked leakage in the paravertebral venous plexus (odds ratio [OR], 1.2; 95% confidence interval [CI], 0.1–10.3; p=0.000) and previous surgery (OR, 16.1; 95% CI, 4.2–61.0; p=0.007) were independent risk factors for PCE. Regarding patients who had undergone screw augmentation, the marked leakage in the paravertebral venous plexus (OR, 4.2; 95% CI, 0.5–37.3; p=0.004) was the main risk factor.
Conclusion Marked leakage in the paravertebral venous plexus and previous surgery were significant risk factors related to PCE. Paravertebral leakage and operator experience should be concerned when performing PMMA augmentation.
Collapse
Affiliation(s)
- Huizhi Guo
- The first Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China.,Spine Surgery Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Huasheng Huang
- The first Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yang Shao
- The first Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qiuli Qin
- The first Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - De Liang
- Spine Surgery Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shuncong Zhang
- Spine Surgery Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yongchao Tang
- Spine Surgery Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| |
Collapse
|
8
|
Gomes de Farias LDP, Richter I, Mouallem ARE, Baptista LDPS. Cardiac Embolization of Polymethylmethacrylate after Thoracolumbar Spinal Arthrodesis. Radiol Cardiothorac Imaging 2021; 3:e210125. [PMID: 34778783 PMCID: PMC8581580 DOI: 10.1148/ryct.2021210125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/16/2021] [Accepted: 08/31/2021] [Indexed: 06/13/2023]
|
9
|
Risk factor analysis of pulmonary cement embolism during percutaneous vertebroplasty or kyphoplasty for osteoporotic vertebral compression fractures. J Orthop Surg Res 2021; 16:312. [PMID: 33985550 PMCID: PMC8117622 DOI: 10.1186/s13018-021-02472-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/06/2021] [Indexed: 01/19/2023] Open
Abstract
Objective The purpose of this research is to evaluate the risk factors and incidence of pulmonary cement embolism (PCE) during percutaneous vertebroplasty (PVP) or kyphoplasty (PKP) for osteoporotic vertebral compression fractures (OVCFs) based on postoperative computed tomography (CT). Methods A total of 2344 patients who underwent PVP or PKP due to OVCFs in our spine center were analyzed retrospectively. According to the detection of postoperative pulmonary CT, the patients were divided into two groups: pulmonary cement embolism group (PCE group) and non-pulmonary cement embolism group (NPCE group). Demographic data in both groups were compared using the χ2 test for qualitative data and the unpaired t test for quantitative data. Multiple logistic regression analysis was carried out to identify risk factors that were significantly related to the PCE resulting from cement leakage. Results PCE was found in 34 patients (1.9% 34/1782) with pulmonary CT examination after operation. There was no statistically significant difference in the parameters such as age, gender, body mass index (BMI), and cement volume in the two groups. Patients with three or more involved vertebrae had a significantly increased risk to suffer from PCE than those with one involved vertebra (p=0.046 OR 2.412 [95% CI 1.017–5.722]). Patients who suffered thoracic fracture had a significantly increased risk to suffer from PCE than those who suffered thoracolumbar fracture (p=0.001 OR 0.241 [95% CI 0.105–0.550]). And significantly increased PCE risk also was observed in thoracic fracture compared with lumbar fracture patients (p=0.028 OR 0.094 [95% CI 0.114–0.779]). The risk of PCE within 2 weeks after fracture was significantly higher than that after 2 weeks of fracture (p=0.000 OR 0.178 [95% CI 0.074–0.429]). Patients who underwent PVP surgery had a significantly increased PCE risk than those who underwent PKP surgery (p=0.001 OR 0.187 [95% CI 0.069–0.509]). Conclusion The real incidence of PCE is underestimated due to the lack of routine postoperative pulmonary imaging examination. The number of involved vertebrae, fracture location, operation timing, and operation methods are independent risk factors for PCE.
Collapse
|
10
|
Naud R, Guinde J, Astoul P. Pulmonary cement embolism complicating percutaneous kyphoplasty: A case report. Respir Med Case Rep 2020; 31:101188. [PMID: 32923362 PMCID: PMC7475197 DOI: 10.1016/j.rmcr.2020.101188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/10/2020] [Accepted: 08/08/2020] [Indexed: 02/06/2023] Open
Abstract
Background Vertebral cement augmentation procedures, as kyphoplasty (KP) or percutaneous vertebroplasty (PVP), are commonly used for the management of pain of the vertebral column usually due to fractures related to traumatic injury, osteoporosis or metastatic lesion. It is a useful and safe technique with few complications. Among them, symptomatic pulmonary cement embolism (PCE) can happened, even rarely described in the literature, leading to severe cardio-respiratory manifestations depending on the location and size of the cement emboli. Case presentation A 55 yo woman presented with atypical chest pain and presyncope three weeks after a motor vehicle accident resulting in an L1 compression fracture treated with kyphoplasty. She was hemodynamically stable. Blood tests showed D-Dimer 0.29 μg/mL, troponin <5ng/mL, Brain Natriuretic Protein 14 ng/mL and a PaO2 of 99 mmHg on arterial blood gas analysis. A computed tomography scan of chest showed linear hyperdense foreign bodies in two segmental pulmonary arteries at the level of middle lobe and right lower lobe compatible with pulmonary cement embolism. Anticoagulation with rivaroxaban for sixth months resulted in resolution of symptoms. Conclusions In this case, the pulmonary cement embolism occurred after kyphoplasty, which is associated with less risk of PCE than vertebroplasty. The procedure was done under biplanar fluoroscopy and no leakage of cement was noted, which would raise suspicion for CPE. Repeat imagine after this procedure is not routinely done. This case demonstrates that systematic imaging post procedure should be considered. An anticoagulation with rivaroxaban seems to be effective in our patient.
Collapse
Affiliation(s)
- Romain Naud
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Hôpital Nord, Marseille, France
| | - Julien Guinde
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Hôpital Nord, Marseille, France
| | - Philippe Astoul
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Hôpital Nord, Marseille, France.,Aix-Marseille University, France
| |
Collapse
|
11
|
Zhang C, Han X, Li L, Zhang C, Ma Y, Wang G. Posterior Decompression Surgery and Radiofrequency Ablation Followed by Vertebroplasty in Spinal Metastases from Lung Cancer. Med Sci Monit 2020; 26:e925169. [PMID: 32705998 PMCID: PMC7401824 DOI: 10.12659/msm.925169] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background Spinal metastases can cause metastatic epidural spinal cord compression (MESCC), which can result in neurological dysfunction and impaired quality of life. This study investigated the safety and effectiveness of posterior decompression surgery and radiofrequency ablation followed by vertebroplasty in spinal metastasis from lung cancer. Material/Methods From June 2008 to September 2015, a retrospective analysis was conducted in 15 patients with spinal metastasis from lung cancer. All cases suffered MESCC and underwent posterior decompression surgery to relieve the compression of spinal cord, and had radiofrequency ablation followed by vertebroplasty. All patients received postoperative multidisciplinary therapy. The operative time, blood loss, complications, pain, neurologic deficit, quality of life, and survival were assessed preoperatively and postoperatively. Results Patients were followed from 6 to 56 months. The mean time of operation was 154±50 minutes and the mean blood loss was 210±90 mL. In the pre-operation analysis found the mean visual analogue scale (VAS) was 7.86±0.86. In the post-operation analysis at 3 months, the mean VAS score was 3.51±1.32. The VAS improved significantly (t=7.95, P<0.01). The Frankel grade was improved 1 grade or 2 grades in 14 patients when pre-operation was compared to post-operation. Only 1 patient kept Frankel grade D after surgery. Eight patients with sphincteric dysfunction preoperatively were improved after surgery. The EORTC QLQ-C30 score was 86.13±8.51 preoperatively and 52.21±13.28 postoperatively. The quality of life was improved significantly (t=11.8, P<0.01). The median survival time was 11 months. Conclusions Through posterior decompression surgery and radiofrequency ablation followed by vertebroplasty, the quality of life was improved significantly. This palliative treatment was effective and safe in spinal metastasis from lung cancer.
Collapse
Affiliation(s)
- Chao Zhang
- Department of Bone and Soft Tissue Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China (mainland)
| | - Xiuxin Han
- Department of Bone and Soft Tissue Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China (mainland)
| | - Lili Li
- Department of Bone and Soft Tissue Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China (mainland)
| | - Chao Zhang
- Department of Bone and Soft Tissue Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China (mainland)
| | - Yulin Ma
- Department of Bone and Soft Tissue Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China (mainland)
| | - Guowen Wang
- Department of Bone and Soft Tissue Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China (mainland)
| |
Collapse
|
12
|
Pigna F, Calamai S, Scioscioli F, Buttarelli L, Nicolini F, Cervellin G. Thorned heart. Description of a near-fatal cardiac embolism after percutaneous Vertebroplasty. EMERGENCY CARE JOURNAL 2020. [DOI: 10.4081/ecj.2020.8739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Cement extravasation is a rather common complication of vertebroplasty, which can be observed in up to 30-40% of patients undergoing this procedure, further associated with venous leakage occurring in up to 24% of cases. Pulmonary embolism may eventually develop once the cement migrates within the pulmonary artery, and is the most common complication of cement extravasation (involving ~4.6% of patients). Intra-cardiac cement embolism is considerably less frequent, but is a potentially fatal complication, mostly managed with cardiac surgery. We describe here a rare case of near-fatal cardiac cement embolism, with a large fragment perforating the right ventricle and reaching the pericardium, who presented to the Emergency Department (ED) for syncope. The patient, who displayed this severe complication after a vertebroplasty procedure performed for osteoporotic compression fracture, needed cardiac surgery.
Collapse
|
13
|
Hsieh MK, Kao FC, Chiu PY, Chen LH, Yu CW, Niu CC, Lai PL, Tsai TT. Risk factors of neurological deficit and pulmonary cement embolism after percutaneous vertebroplasty. J Orthop Surg Res 2019; 14:406. [PMID: 31783861 PMCID: PMC6884871 DOI: 10.1186/s13018-019-1459-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 11/06/2019] [Indexed: 02/07/2023] Open
Abstract
Background The risk factors, incidence, and clinical management of pulmonary cement embolism and neurological deficit during percutaneous vertebroplasty (PVP) were evaluated. Methods Three thousand one hundred and seventy-five patients with symptomatic osteoporotic vertebral compression fractures (OVCFs) treated with PVP were retrospectively reviewed in a single institution. Clinical parameters such as age, gender, number of fractures, and time from fracture to vertebroplasty were recorded at the time of surgery. Image and surgical parameters including the amount of cement, the vertebral level, uni- or bipedicle surgical approach, and leakage pattern were recorded. Results Type-C leakage, including paraspinal (25%), intradiscal (26%), and posterior (0.7%) leakage, was more common than type-B (11.4%) and type-S leaks (4.9%). Cement leakage into the spinal canal (type-C posterior) occurred in 26 patients (0.7%), and four patients needed surgical decompression. Three in nine patients with leakage into thoracic spine needed decompressive surgery, but only one of 17 patients into lumbar spine needed surgery (p < 0.01). Age, gender, number of fractures, and time from fracture to vertebroplasty were not risk factors of pulmonary cement embolism or neurological deficit. The risk factor of pulmonary cement embolism was higher volume of PMMA injected (p < 0.001) and risk factor of neurological deficit was type-C posterior cement leakage into thoracic spine. The incidence of pulmonary cement embolism was significantly high in the volume of PMMA injected (PMMA injection < 3.5 cc: 0%; 3.5–7.0 cc: 0.11%; > 7.0 cc: 0.9%; p < 0.01) which needed postoperative oxygen support. Conclusions Cement leakage is relatively common but mostly of no clinical significance. Percutaneous vertebroplasty in thoracic spine and high amount of PMMA injected should be treated with caution in clinical practice.
Collapse
Affiliation(s)
- Ming-Kai Hsieh
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan. .,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan. .,College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Fu-Cheng Kao
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ping-Yeh Chiu
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Lih-Huei Chen
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Wei Yu
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Chien Niu
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Po-Liang Lai
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tsung-Ting Tsai
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| |
Collapse
|
14
|
Sun Y, Zhang H, Xu HR, Liu JZ, Pan J, Zhai HZ, Lu CY, Zhao X, Chen YQ, Zhou LL, Yu J, Han J. Analgesia of percutaneous thermal ablation plus cementoplasty for cancer bone metastases. J Bone Oncol 2019; 19:100266. [PMID: 31788416 PMCID: PMC6880023 DOI: 10.1016/j.jbo.2019.100266] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 10/30/2019] [Accepted: 10/30/2019] [Indexed: 01/06/2023] Open
Abstract
Background The purpose of this study was to review recent research related to the analgesic effect of ablation therapy combined with cementoplasty, as well as to identify the duration of analgesic effect and risk for cement leaks. Methods A systematic literature search using PubMed, Web of Science, and annual meeting proceedings of the oncology society and other organizations were conducted. Results Twelve retrospective studies met the inclusion criteria. Four of the studies included in the review assessed the changes immediately after treatment. Five studies were subjected to analyses of analgesic effect of combined percutaneous thermal ablation and Cementoplasty at 24 weeks after treatment. Incidences of leakage of bone cement during surgery were detected in 4 out of 12 studies. The change of mean pain scores at 1 days, at 1 week, and at 4 weeks, 12 weeks, and 24 weeks after treatment were -3.90 (95% CI: -4.80 to -3.00), -4.55 (95% CI:-5.46 to -3.64), -4.78 (95% CI: -5.70 to -3.86), -5.16 (95% CI: -6.39 to -3.92), and -5.91 (95% CI: -6.63 to -5.19). The relative risk of cement leakage was 0.10 (95% CI: -6.63 to -5.19). Conclusions Our systematic review suggested that thermal ablation combined with cementoplasty could be a safe and effective intervention for the management of bone metastases-induced pain.
Collapse
Affiliation(s)
- Yuandong Sun
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Shandong Cancer Hospital and Institute, Jinan, 250117, PR China
| | - Hao Zhang
- Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, 250117, PR China
| | - Hui-Rong Xu
- Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, 250117, PR China
| | - Jing-Zhou Liu
- Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, 250117, PR China
| | - Jia Pan
- Mudan District Central Hospital
| | - Hui-Zhuan Zhai
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Shandong Cancer Hospital and Institute, Jinan, 250117, PR China
| | - Chang-Yan Lu
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Shandong Cancer Hospital and Institute, Jinan, 250117, PR China
| | - Xia Zhao
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Shandong Cancer Hospital and Institute, Jinan, 250117, PR China
| | - Ye-Qiang Chen
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Shandong Cancer Hospital and Institute, Jinan, 250117, PR China
| | - Lin-Lin Zhou
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Shandong Cancer Hospital and Institute, Jinan, 250117, PR China
| | - Jinming Yu
- Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, 250117, PR China
| | - Jianjun Han
- Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, 250117, PR China
| |
Collapse
|
15
|
Adu-Gyamfi KO, Patri S. Symptomatic cardiopulmonary cement embolism following vertebroplasty. BMJ Case Rep 2019; 12:12/7/e230603. [PMID: 31311789 DOI: 10.1136/bcr-2019-230603] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
| | - Sandeep Patri
- Internal Medicine, HSHS Saint Vincent Hospital, Green Bay, Wisconsin, USA
| |
Collapse
|
16
|
D'Errico S, Niballi S, Bonuccelli D. Fatal cardiac perforation and pulmonary embolism of leaked cement after percutaneous vertebroplasty. J Forensic Leg Med 2019; 63:48-51. [PMID: 30861473 DOI: 10.1016/j.jflm.2019.03.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 02/25/2019] [Accepted: 03/03/2019] [Indexed: 12/22/2022]
Abstract
Percutaneous vertebroplasty consists of percutaneous injection of polymethylmethacrylate (PMMA) via a transpedicular approach for the treatment of collapsed osteoporotic or metastatic vertebrae. Even if percutaneous vertebroplasty is considered to be minimally invasive, threatening complications can occur. Cement leakage is the most common complication of percutaneous vertebroplasty. Rigorous patient selection and individual therapeutic strategy may reduce the occurrence of leakage, in particular the risk of cement entry into the venous system and the spinal canal is the potent major hazard of this technique. Cement pulmonary and cardiac embolism are reported in literature as a cause of unexpected death after percutaneous vertebroplasty. Authors report a fatal case of pulmonary cement embolization occurred after vertebroplasty with haemopericardium, due to the perforation of the right atrium wall from a cement solidified fragment. A complete post mortem examination documented the presence of multiple cement fragments in the pulmonary arteries and transmural perforation of the wall of the right atrium by a whitish needle-like foreign body. Pulmonary microembolization was observed under polarized light.
Collapse
Affiliation(s)
- Stefano D'Errico
- Department of Legal Medicine, Azienda USL Toscana Nordovest, Lucca, Italy.
| | - Sara Niballi
- Department of Legal Medicine, Azienda USL Toscana Nordovest, Lucca, Italy
| | - Diana Bonuccelli
- Department of Legal Medicine, Azienda USL Toscana Nordovest, Lucca, Italy
| |
Collapse
|
17
|
Rodrigues DM, Cunha Machado DP, Campainha Fernandes SA, Paixão Barroso AM. Pulmonary cement embolism following balloon kyphoplasty: The impact of a procedural complication in a new era for lung cancer management. Mol Clin Oncol 2019; 10:299-303. [PMID: 30680211 DOI: 10.3892/mco.2018.1782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 10/13/2018] [Indexed: 12/30/2022] Open
Abstract
Pulmonary cement embolism (PCE) is a recognized complication of balloon kyphoplasty, a vertebral augmentation technique that stabilizes vertebral compression fractures, alleviating associated pain. Balloon kyphoplasty is particularly relevant when patients with advanced stages of cancer present with longer survival times, and therefore benefit from such augmentation techniques to improve pain and prevent additional complications. The embolization of cement to pulmonary vasculature may be unnoticed given the frequent absence of symptoms and routine imaging tests following the procedure. The present study reports the case of a 58-year-old female with stage IV lung cancer with a painful compression L3 fracture who underwent balloon kyphoplasty with no initially reported complications. The patient maintained the usual respiratory symptoms; therefore, the diagnosis was only made in a routine CT scan 3 months after the surgery. A literature review of PCE is performed, integrating the current evidence regarding diagnosis, therapeutics, prognosis and prevention. Certain poorly clarified aspects are identified as potential investigation starting points.
Collapse
Affiliation(s)
- Daniela Marta Rodrigues
- Department of Pulmonology, Hospital Pedro Hispano, São Mamede de Infesta, 4465-120 Matosinhos, Portugal
| | - Daniela Patrícia Cunha Machado
- Multidisciplinary Unit of Thoracic Tumors, Department of Pulmonology, Centro Hospitalar Vila Nova de Gaia/Espinho, 4434-502 Vila Nova de Gaia, Portugal
| | - Sérgio André Campainha Fernandes
- Multidisciplinary Unit of Thoracic Tumors, Department of Pulmonology, Centro Hospitalar Vila Nova de Gaia/Espinho, 4434-502 Vila Nova de Gaia, Portugal
| | - Ana Maria Paixão Barroso
- Multidisciplinary Unit of Thoracic Tumors, Department of Pulmonology, Centro Hospitalar Vila Nova de Gaia/Espinho, 4434-502 Vila Nova de Gaia, Portugal
| |
Collapse
|
18
|
Fadili Hassani S, Cormier E, Shotar E, Drir M, Spano JP, Morardet L, Collet JP, Chiras J, Clarençon F. Intracardiac cement embolism during percutaneous vertebroplasty: incidence, risk factors and clinical management. Eur Radiol 2018; 29:663-673. [DOI: 10.1007/s00330-018-5647-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 06/26/2018] [Accepted: 07/03/2018] [Indexed: 11/25/2022]
|
19
|
Rahimi B, Boroofeh B, Dinparastisaleh R, Nazifi H. Cement pulmonary embolism after percutaneous vertebroplasty in a patient with cushing's syndrome: A case report. Respir Med Case Rep 2018; 25:78-85. [PMID: 30073141 PMCID: PMC6068333 DOI: 10.1016/j.rmcr.2018.06.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 06/16/2018] [Accepted: 06/17/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Vertebroplasty is a procedure most commonly used for vertebral compression fractures. Although it is a relatively safe procedure, complications have been reported. Cement embolism is seen in 2.1%-26% of patients after percutaneous vertebroplasty. CASE PRESENTATION a 38-year-old male who was diagnosed with cushing's syndrome, underwent percutaneous vertebroplasty for his thoracic osteoporotic compression fractures. 24-hours following vertebroplasty, he presented to emergency department with acute-onset dyspnea and chest pain. Chest radiography showed an opaque linear lesion in left pulmonary artery which was suggestive of cement embolism. Pulmonary spiral CT-scan further confirmed the diagnosis. The patient's symptoms improved over time, and warfarin was started with close cardiopulmonary assessments for indicators of cement embolus removal. CONCLUSION in patients with pulmonary cement embolism, conservative treatment may be recommended rather than a surgical removal except when the obstruction is extensive enough to cause hemodynamic changes. Given that all the related studies have suggested that pulmonary thromboembolism can occur as a complication due to bone cement leakage, discovering new cement alternatives and/or injection devices, seems beneficial.
Collapse
Affiliation(s)
- Besharat Rahimi
- Pulmonology Department, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Behdad Boroofeh
- Pulmonology Department, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Roshan Dinparastisaleh
- Internal Medicine Department, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
| | - Hale Nazifi
- Internal Medicine Department, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
| |
Collapse
|
20
|
Park JS, Kim J, Lee Y, Gwon JG, Park YS. Intra-cardiac Embolism of a Large Bone Cement Material after Percutaneous Vertebroplasty Removed through a Combination of an Endovascular Procedure and an Inferior Vena Cava Exploration: a Case Report. J Korean Med Sci 2018; 33:e141. [PMID: 29736157 PMCID: PMC5934517 DOI: 10.3346/jkms.2018.33.e141] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 01/30/2018] [Indexed: 11/21/2022] Open
Abstract
Percutaneous vertebroplasty (PVP) is a minimally invasive surgical treatment for patients with osteoporotic vertebral compression fracture (OVCF) and can rapidly alleviate pain, improve mobility, and stabilize the vertebrae. However, it has the potential to cause complications such as cement embolism. A 55-year-old female presented with pain in the lumbar region as a chief complaint. PVP was performed after diagnosis of acute OVCFs at L4 and L5. No abnormal symptoms were reported after surgery, but a large cement embolism was observed in her right atrium and ventricle. After discussion in a multi-disciplinary team, the large cement embolism was successfully removed by a combination of endovascular procedure and an inferior vena cava exploration. Surgeons must consider the possibility of intra-cardiac cement embolism after PVP. A hybrid approach of an endovascular procedure and a vascular surgery may be a reasonable treatment option to minimize the surgical procedure in cases of a large intra-cardiac cement embolism.
Collapse
Affiliation(s)
- Jin-Sung Park
- Department of Orthopedic Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Jaedong Kim
- Department of Orthopedic Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Yonggu Lee
- Department of Cardiology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Jun-Gyo Gwon
- Department of Vascular Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Ye-Soo Park
- Department of Orthopedic Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| |
Collapse
|
21
|
Pulmonary Embolism from Cement Augmentation of the Vertebral Body. Asian Spine J 2018; 12:380-387. [PMID: 29713422 PMCID: PMC5913032 DOI: 10.4184/asj.2018.12.2.380] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 06/20/2017] [Accepted: 07/12/2017] [Indexed: 12/17/2022] Open
Abstract
Pulmonary cement embolism (PCE) can follow cement augmentation procedures for spine fractures due to osteoporosis, traumatic injuries, and painful metastatic lesions. PCE is underreported and it is likely that many cases remain undiagnosed. Risk factors for PCE have been identified, which can help alert clinicians to patients likely to develop the condition, and there are recommended techniques to reduce its incidence. Most patients with PCE are asymptomatic or only develop transient symptoms, although a few may exhibit florid cardiorespiratory manifestations which can ultimately be fatal. Diagnosis is mainly by radiographic means, commonly using simple radiographs and computed tomography scans of the chest with ancillary tests that assess the patient's cardiorespiratory condition. Management depends on the location and size of the emboli as well as the patient's symptomatology. The aim of this review is to raise awareness of the not uncommon complications of PCE following vertebral cement augmentation and the possibility of serious sequelae. Recommendations for the diagnosis and management of PCE are presented, based on the most recent literature.
Collapse
|
22
|
Mansour A, Abdel-Razeq N, Abuali H, Makoseh M, Shaikh-Salem N, Abushalha K, Salah S. Cement pulmonary embolism as a complication of percutaneous vertebroplasty in cancer patients. Cancer Imaging 2018; 18:5. [PMID: 29422089 PMCID: PMC5806228 DOI: 10.1186/s40644-018-0138-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 01/25/2018] [Indexed: 12/21/2022] Open
Abstract
Background Vertebroplasty is a minimally invasive procedure commonly performed for vertebral compression fractures secondary to osteoporosis or malignancy. Leakage of bone cement into the paravertebral venous system and cement pulmonary embolism (cPE) are well described, mostly in patients with osteoporosis. Little is known about the clinical sequelae and outcomes in cancer patients. In this study, we report our experience with cPE following vertebroplasty performed in cancer patients. Methods Records of all consecutive cancer patients who underwent vertebroplasty at our institution were retrospectively reviewed. The procedure was performed via percutaneous injection of barium-opacified polymethyl-methacrylate cement. Results A total of 102 cancer patients with a median age of 53 (19–83) years were included. Seventy-eight (76.5%) patients had malignant vertebral fractures, and 24 (23.5%) patients had osteoporotic fractures. Cement PE was detected in 13 (12.7%) patients; 10 (76.9%) patients had malignant fractures, and the remaining three had osteoporotic fractures. Cement PE was mostly asymptomatic; however, 5 (38.5%) patients had respiratory symptoms that led to the diagnosis. Only the five symptomatic patients were anticoagulated. Cement PE was more common with multiple myeloma (MM); it occurred in 7 (18.9%) of the 37 patients with MM compared with only three (7.3%) of the 41 patients with other malignancies. No difference in incidence was observed between patients with osteoporotic or malignant vertebral fractures. Conclusions Cement PE is a relatively common complication following vertebroplasty and is mostly asymptomatic. Multiple myeloma is associated with the highest risk. Large-scale prospective studies can help identify risk factors and clinical outcomes and could lead to better prevention and therapeutic strategies.
Collapse
Affiliation(s)
- Asem Mansour
- Department of Radiology, King Hussein Cancer Center, Amman, Jordan.
| | | | - Hussein Abuali
- Department of Radiology, King Hussein Cancer Center, Amman, Jordan
| | - Mohammad Makoseh
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | | | - Kamelah Abushalha
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Samer Salah
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| |
Collapse
|
23
|
Chiras J, Shotar E, Cormier E, Clarençon F. Interventional radiology in bone metastases. Eur J Cancer Care (Engl) 2017; 26. [DOI: 10.1111/ecc.12741] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2017] [Indexed: 11/28/2022]
Affiliation(s)
- J. Chiras
- Department of Interventional Neuroradiology; Pitié-Salpêtrière Hospital; Paris France
- Paris VI University; Pierre et Marie Curie; Paris France
| | - E. Shotar
- Department of Interventional Neuroradiology; Pitié-Salpêtrière Hospital; Paris France
- Paris VI University; Pierre et Marie Curie; Paris France
| | - E. Cormier
- Department of Interventional Neuroradiology; Pitié-Salpêtrière Hospital; Paris France
| | - F. Clarençon
- Department of Interventional Neuroradiology; Pitié-Salpêtrière Hospital; Paris France
- Paris VI University; Pierre et Marie Curie; Paris France
| |
Collapse
|
24
|
Wolman DN, Heit JJ. Recent advances in Vertebral Augmentation for the treatment of Vertebral body compression fractures. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2017. [DOI: 10.1007/s40141-017-0162-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
25
|
Elderly Woman With Altered Mental Status and Hypoxia. Ann Emerg Med 2016; 68:778-789. [PMID: 27894631 DOI: 10.1016/j.annemergmed.2016.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Indexed: 11/23/2022]
|
26
|
Saracen A, Kotwica Z. Complications of percutaneous vertebroplasty: An analysis of 1100 procedures performed in 616 patients. Medicine (Baltimore) 2016; 95:e3850. [PMID: 27310966 PMCID: PMC4998452 DOI: 10.1097/md.0000000000003850] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Percutaneous vertebroplasty (PVP) is a minimally invasive procedure widely used for the treatment of pain due to vertebral fractures of different origins-osteoporotic, traumatic, or neoplastic. PVP is minimally invasive, but the complications are not rare; however, they are in most cases not significant clinically. The most frequent is cement leakage, which can occur onto veins, paravertebral soft tissue, into the intervertebral disk, or to the spinal canal, affecting foraminal area or epidural space. We analyzed results of treatment and complications of vertebroplasty performed with the use of polimethylomethylacrylate cement (PMMA) on 1100 vertebrae, with a special regard to the severity of complication and eventual clinical manifestation. One thousand one hundred PVP were analyzed, performed in 616 patients. There were 468 (76%) women and 148 men (24%), 24 to 94-year old, mean age 68 years. From 1100 procedures, 794 treated osteporotic and 137 fractures due to malignant disease, 69 PVP were made in traumatic fractures. One hundred patients had painful vertebral hemangiomas. Seven hundred twenty-six (66%) lesions were in thoracic, and 374 (34%) in lumbar area. Results of treatment were assessed using 10 cm Visual Analogue Scale (VAS) 12 hours after surgery, 7 days, 30 days, and then each 6 months, up to 3 years. Before surgery all patients had significant pain 7 to 10 in VAS scale, mean 8.9 cm. Twelve hours after surgery 602 (97.7%) reported significant relief of pain, with mean VAS of 2,3 cm. Local complications occurred in 50% of osteoporotic, 34% of neoplastic, 16% of traumatic fractures, and 2% of vertebral hemangiomas. The most common was PMMA leakage into surrounding tissues-20%; paravertebral vein embolism-13%; intradiscal leakage-8%; and PMMA leakage into the spinal canal-0.8%. Results of treatment did not differ between patients with and without any complications. From 104 patients who had chest X-ray or CT study performed after surgery, pulmonary embolism was noted in 2 patients, but without any clinical symptoms. Only 1 patient-with PMMA leakage into the spinal canal required surgical decompression In conclusion, PVP is effective in decreasing the level of pain in compression vertebral fractures. Complications occur in almost half of the patients but in more than 95% of them do not produce any clinical symptoms.
Collapse
|
27
|
A rock in a hard place: Cement pulmonary emboli after percutaneous vertebroplasty. Int J Cardiol 2016; 208:162-3. [PMID: 26871310 DOI: 10.1016/j.ijcard.2016.01.176] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 01/12/2016] [Indexed: 12/26/2022]
|
28
|
Sinha N, Padegal V, Satyanarayana S, Santosh HK. Pulmonary cement embolization after vertebroplasty, an uncommon presentation of pulmonary embolism: A case report and literature review. Lung India 2015; 32:602-5. [PMID: 26664167 PMCID: PMC4663864 DOI: 10.4103/0970-2113.168119] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pulmonary Cement Embolization (PCE) is a rare complication of vertebroplasty surgery. There is no clear guideline for management of this entity. There is no definite protocol for anticoagulation in PCE. This is a case report of our patient who was diagnosed to have Pulmonary Cement Embolization, which was quite significant involving both lungs. She was successfully managed without long term anticoagulation.
Collapse
Affiliation(s)
- Nishant Sinha
- Department of Respiratory Medicine, Fortis Hospitals, Bangaluru, Karnataka, India
| | - Vivek Padegal
- Department of Respiratory Medicine, Fortis Hospitals, Bangaluru, Karnataka, India
| | | | | |
Collapse
|
29
|
Focardi M, Bonelli A, Pinchi V, De Luca F, Norelli GA. Pulmonary Cement Embolism After Kyphoplasty. J Forensic Sci 2015; 61 Suppl 1:S252-5. [DOI: 10.1111/1556-4029.12957] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 01/27/2015] [Accepted: 02/08/2015] [Indexed: 01/07/2023]
Affiliation(s)
- Martina Focardi
- Department of Health Sciences; Forensic Medicine Section; University of Florence; Largo Brambilla 3 Florence 50134 Italy
| | - Aurelio Bonelli
- Department of Health Sciences; Forensic Medicine Section; University of Florence; Largo Brambilla 3 Florence 50134 Italy
| | - Vilma Pinchi
- Department of Health Sciences; Forensic Medicine Section; University of Florence; Largo Brambilla 3 Florence 50134 Italy
| | - Federica De Luca
- Department of Health Sciences; Forensic Medicine Section; University of Florence; Largo Brambilla 3 Florence 50134 Italy
| | - Gian-Aristide Norelli
- Department of Health Sciences; Forensic Medicine Section; University of Florence; Largo Brambilla 3 Florence 50134 Italy
| |
Collapse
|
30
|
Cha YH. Pulmonary Bone Cement Embolism Following Percutaneous Vertebroplasty. JOURNAL OF TRAUMA AND INJURY 2015. [DOI: 10.20408/jti.2015.28.3.202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Yong Han Cha
- Department of Orthopedic Surgery, Eulji University College of Medicine, Daejeon, Korea
| |
Collapse
|
31
|
Pulmonary cement embolism after navigated pedicle screw placement. CURRENT ORTHOPAEDIC PRACTICE 2015. [DOI: 10.1097/bco.0000000000000274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
32
|
Radiologie interventionnelle des métastases osseuses. ONCOLOGIE 2015. [DOI: 10.1007/s10269-015-2493-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
33
|
Amin SB, Slater R, Mohammed TLH. Pulmonary calcifications: a pictorial review and approach to formulating a differential diagnosis. Curr Probl Diagn Radiol 2015; 44:267-76. [PMID: 25812931 DOI: 10.1067/j.cpradiol.2014.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Accepted: 12/30/2014] [Indexed: 01/15/2023]
Abstract
Pulmonary calcifications encompass a wide range of causes, both common and rare, such as calcified pulmonary nodules from chronic fungal infections and pulmonary alveolar microlithiasis. In this pictorial review, we categorize them based on etiology, which includes neoplastic calcifications, nonneoplastic calcified nodules, and iatrogenic- and exposure-related causes of pulmonary calcifications. We also illustrate the most characteristic imaging findings and outline the clinical implications for each of these entities to provide a sensible approach to pulmonary calcifications.
Collapse
Affiliation(s)
- Sagar B Amin
- College of Medicine, University of Florida, Gainesville, FL; Department of Radiology, UF Health Shands Hospital, Gainesville, FL.
| | - Robbie Slater
- College of Medicine, University of Florida, Gainesville, FL; Department of Radiology, UF Health Shands Hospital, Gainesville, FL
| | - Tan-Lucien H Mohammed
- College of Medicine, University of Florida, Gainesville, FL; Department of Radiology, UF Health Shands Hospital, Gainesville, FL
| |
Collapse
|
34
|
Pulmonary Cement Embolism following Percutaneous Vertebroplasty. Case Rep Pulmonol 2014; 2014:851573. [PMID: 25580343 PMCID: PMC4279129 DOI: 10.1155/2014/851573] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Accepted: 11/28/2014] [Indexed: 12/18/2022] Open
Abstract
Percutaneous vertebroplasty is a minimal invasive procedure that is applied for the treatment of osteoporotic vertebral fractures. During vertebroplasty, the leakage of bone cement outside the vertebral body leads to pulmonary cement embolism, which is a serious complication of this procedure. Here we report a 48-year-old man who was admitted to our hospital with dyspnea after percutaneous vertebroplasty and diagnosed as pulmonary cement embolism.
Collapse
|
35
|
Rothermich MA, Buchowski JM, Bumpass DB, Patterson GA. Pulmonary cement embolization after vertebroplasty requiring pulmonary wedge resection. Clin Orthop Relat Res 2014; 472:1652-7. [PMID: 24532433 PMCID: PMC3971236 DOI: 10.1007/s11999-014-3506-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 02/04/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Pulmonary cement embolization after vertebroplasty is a well-known complication but typically presents with minimal respiratory symptoms. Although this rare complication has been reported, the current literature does not address the need for awareness of symptoms of potentially devastating respiratory compromise. CASE DESCRIPTION We present the case of a 29-year-old man who underwent T11 vertebroplasty and subsequently had chest pain develop several days later. His right lower lung lobe had infarcted owing to massive cement embolization to his pulmonary arterial circulation. Open pulmonary wedge resection and embolectomy were performed. The patient recovered from the embolectomy but had chronic, persistent respiratory symptoms after surgery. LITERATURE REVIEW Operative management of vertebral compression fractures has included percutaneous vertebroplasty for the past 25 years. The reported incidence of pulmonary cement emboli after vertebroplasty ranges from 2.1% to 26% with much of this variation resulting from which radiographic technique is used to detect embolization. Symptoms of pulmonary cement embolism can occur during the procedure, but more commonly begin days to weeks, even months, after vertebroplasty. At least six deaths from cement embolization after vertebroplasty have been reported. Most cases of pulmonary cement emboli with cardiovascular and pulmonary complications are treated nonoperatively with anticoagulation. Endovascular removal of large cement emboli from the pulmonary arteries is not without risk and sometimes requires open surgery for complete removal of cement pieces. CLINICAL RELEVANCE Pulmonary cement embolism is a potentially serious complication of vertebroplasty. If a patient has chest pain or respiratory difficulty after the procedure, chest radiography and possibly advanced chest imaging studies should be performed immediately.
Collapse
Affiliation(s)
- Marcus A. Rothermich
- Department of Orthopaedic Surgery, Washington University in St Louis, 660 S Euclid Avenue, Campus Box 8233, St Louis, MO 63110 USA
| | - Jacob M. Buchowski
- Department of Orthopaedic Surgery, Washington University in St Louis, 660 S Euclid Avenue, Campus Box 8233, St Louis, MO 63110 USA
| | - David B. Bumpass
- Department of Orthopaedic Surgery, Washington University in St Louis, 660 S Euclid Avenue, Campus Box 8233, St Louis, MO 63110 USA
| | - G. Alexander Patterson
- Department of Orthopaedic Surgery, Washington University in St Louis, 660 S Euclid Avenue, Campus Box 8233, St Louis, MO 63110 USA
| |
Collapse
|
36
|
Satake K, Kanemura T, Yamaguchi H, Matsumoto A. Pulmonary Embolism After Vertebroplasty with Use of Hydroxyapatite Blocks: A Case Report. JBJS Case Connect 2013; 3:e132. [PMID: 29252288 DOI: 10.2106/jbjs.cc.m.00159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Kotaro Satake
- Department of Orthopaedic Surgery, Konan Kosei Hospital, 137 Takayamachi Ohmatsubara, Konan, Japan 483-8704.
| | - Tokumi Kanemura
- Department of Orthopaedic Surgery, Konan Kosei Hospital, 137 Takayamachi Ohmatsubara, Konan, Japan 483-8704.
| | - Hidetoshi Yamaguchi
- Department of Orthopaedic Surgery, Konan Kosei Hospital, 137 Takayamachi Ohmatsubara, Konan, Japan 483-8704.
| | - Akiyuki Matsumoto
- Department of Orthopaedic Surgery, Nagoya University, 56 Tsurumacho Showa-ku, Nagoya, Japan 466-8550
| |
Collapse
|
37
|
Incidence of Pulmonary Cement Embolism after Real-Time CT Fluoroscopy–guided Vertebroplasty. J Vasc Interv Radiol 2013; 24:1853-60. [DOI: 10.1016/j.jvir.2013.05.048] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 05/14/2013] [Accepted: 05/20/2013] [Indexed: 11/20/2022] Open
|
38
|
Gosev I, Nascimben L, Huang PH, Mauri L, Steigner M, Mizuguchi A, Shah AM, Aranki SF. Right ventricular perforation and pulmonary embolism with polymethylmethacrylate cement after percutaneous kyphoplasty. Circulation 2013; 127:1251-3. [PMID: 23509033 DOI: 10.1161/circulationaha.112.144535] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Igor Gosev
- Divisions of Cardiac Surgery and Interventional Cardiology, Brigham and Women's Hospital, 75 Frances St, Boston, MA 02115, USA.
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Asymptomatic bone cement pulmonary embolism after vertebroplasty: case report and literature review. Case Rep Surg 2013; 2013:591432. [PMID: 23738182 PMCID: PMC3662203 DOI: 10.1155/2013/591432] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 04/15/2013] [Indexed: 11/17/2022] Open
Abstract
Introduction. Acrylic cement pulmonary embolism is a potentially serious complication following vertebroplasty. Case Report. A 70-year-old male patient was treated with percutaneous vertebroplasty for osteoporotic nontraumatic vertebral collapse of L5-S1. Asymptomatic pulmonary cement embolism was detected on routine postoperative chest radiogram and the patient was treated with enoxaparin, amoxicillin, and dexamethasone. At the followup CT scan no further migration of any cement material was reported; and the course was uneventful. Discussion. The frequency of local leakage of bone cement is relatively high (about 80–90%), moreover, the rate of cement leakage into the perivertebral veins (seen in up to 24% of vertebral bodies treated) with consequent pulmonary cement embolism varies from 4.6 to 6.8% (up to 26% in radiologic studies); the risk of embolism is increased with the liquid consistency of the cement and with the treatment of some malignant lesions. Patients may remain asymptomatic and develop no known long-term sequelae. Conclusions. Our ancedotal case illustrates the need for close monitoring of patients undergoing percutaneous vertebroplasty and emphasizes the importance of prompt and correct diagnosis and treatment, even if actually there is no agreement regarding the therapeutic strategy.
Collapse
|
40
|
Tsai YW, Hsiao FY, Wen YW, Kao YH, Chang LC, Huang WF, Peng LN, Liu CL, Chen LK. Clinical Outcomes of Vertebroplasty or Kyphoplasty for Patients With Vertebral Compression Fractures: A Nationwide Cohort Study. J Am Med Dir Assoc 2013; 14:41-7. [DOI: 10.1016/j.jamda.2012.09.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 09/03/2012] [Accepted: 09/05/2012] [Indexed: 11/16/2022]
|
41
|
[Cement augmentation for osteoporotic compression fractures]. Unfallchirurg 2012; 115:1066-9. [PMID: 23247933 DOI: 10.1007/s00113-012-2307-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
High-quality evidence has raised significant questions on the widespread use of vertebroplasty in the treatment of osteopenic vertebral insufficiency fractures. Further research is shifting the burden of proof on procedures such as balloon kyphoplasty and other interventions. New prospective clinical trials may need to consider including sham arms to enhance their relevance.
Collapse
|
42
|
Trumm CG, Pahl A, Helmberger TK, Jakobs TF, Zech CJ, Stahl R, Paprottka PM, Sandner TA, Reiser MF, Hoffmann RT. CT fluoroscopy-guided percutaneous vertebroplasty in spinal malignancy: technical results, PMMA leakages, and complications in 202 patients. Skeletal Radiol 2012; 41:1391-400. [PMID: 22286549 DOI: 10.1007/s00256-012-1365-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2011] [Revised: 10/17/2011] [Accepted: 01/09/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To retrospectively evaluate the incidence and clinical impact of local polymethylmethacrylate (PMMA) leaks and pulmonary cement embolisms occurring under CT fluoroscopy-guided vertebroplasty of symptomatic malignant vertebral osteolyses. MATERIALS AND METHODS From December 2001 to June 2009, 202 cancer patients (116 women, 86 men; age 63.2±8.6 years) with painful malignant vertebral osteolyses underwent vertebroplasty, with or without vertebral compression fracture. A total of 331 vertebrae were treated in 231 sessions under CT fluoroscopy guidance (120 kV; 10–25 mA; single slice, 4-, 16-, and 128-row CT). In the pre-vertebroplasty CT, the following items were assessed: osteolytic destruction (0, ≤25, ≤50, ≤75, or ≤100%) of vertebral cross-sectional area, posterior wall, and circumference; presence of perivertebral and degree of epidural (no, mild, moderate) soft tissue involvement. Local PMMA leaks were analyzed using the post-vertebroplasty CT. Pulmonary cement embolisms were evaluated in all patients having undergone radiography (CR; n053) or CT (n088) of the chest after vertebroplasty due to their underlying disease. Patient charts were reviewed regarding adverse events. RESULTS Of 331 treated vertebrae, 32, 20.2, and 15.7% showed more than 50% osteolytic involvement of the vertebral cross-sectional area, posterior wall, and circumference, respectively. Mild or moderate epidural involvement was seen in 13.0 and 8.4%. Local PMMA leakage rate was 58.6% (194 of 331 vertebrae). Pulmonary cement embolisms (segmental, n010; central, n01) were seen after 7.8% of the procedures with follow-up imaging of the chest. No major complications occurred within a 30-day period after vertebroplasty. CONCLUSION Vertebroplasty of spinal malignancy can be safely performed under CT fluoroscopy guidance even in patients with substantial osteolytic involvement. In our patient collective, PMMA leaks and pulmonary cement embolisms visualized in post-procedural radiography and CT images had no clinical impact.
Collapse
Affiliation(s)
- Christoph G Trumm
- Department of Clinical Radiology, Klinikum der Ludwig-Maximilians-Universität München-Großhadern, Marchioninistrasse 15, 81377 Munich, Germany.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Matouk CC, Krings T, Ter Brugge KG, Smith R. Cement embolization of a segmental artery after percutaneous vertebroplasty: a potentially catastrophic vascular complication. Interv Neuroradiol 2012; 18:358-62. [PMID: 22958778 DOI: 10.1177/159101991201800318] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Accepted: 04/07/2012] [Indexed: 11/16/2022] Open
Abstract
Serious complications related to percutaneous vertebral augmentation procedures, vertebroplasty and kyphoplasty, are rare and most often result from local cement leakage or venous embolization. We describe an adult patient who underwent multi-level, thoracic percutaneous vertebral augmentation procedures for painful osteoporotic compression fractures. The patient's percutaneous vertebroplasty performed at the T9 level was complicated by the asymptomatic, direct embolization of the right T9 segmental artery with penetration of cement into the radicular artery beneath the pedicle. We review the literature regarding the unusual occurrence of direct arterial cement embolization during vertebral augmentation procedures, discuss possible pathomechanisms, and alert clinicians to this potentially catastrophic vascular complication.
Collapse
Affiliation(s)
- C C Matouk
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA.
| | | | | | | |
Collapse
|
44
|
Martin DJ, Rad AE, Kallmes DF. Prevalence of extravertebral cement leakage after vertebroplasty: procedural documentation versus CT detection. Acta Radiol 2012; 53:569-72. [PMID: 22637642 DOI: 10.1258/ar.2012.120222] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Reported incidence of extravertebral cement leakage after vertebroplasty varies widely across studies. PURPOSE To retrospectively compare the relative detection rates of extravertebral leakage noted under intra-procedural fluoroscopic surveillance, postprocedure plain radiographs, and postprocedure computed tomography (CT) in a cohort of patients undergoing vertebroplasty. MATERIAL AND METHODS With IRB approval, we retrospectively identified 181 patients with 277 levels treated with percutaneous vertebroplasty among a total of 1255 patients undergoing vertebroplasty between 1999 and 2010 who had subsequently undergone a CT examination that included the treated level(s). Categories of leakage were paravertebral, end plate, epidural, and prevertebral venous leakage. CT-detected leak rates were then compared to those noted on the vertebroplasty procedure reports and the archived fluoroscopic images for this same cohort using Pearson's χ(2) test. RESULTS One hundred and forty-nine (82%, 95% CI 76-87%) of 181 patients demonstrated evidence of some type of leakage on CT at one or more treated levels. Sixty-two (34%, 95% CI 28-42%) and seventy-seven (50%, 95% CI 43-57%) of 149 CT-detected leaks were reported in the procedural dictation or detected on plain radiography (P = 0.01 and 0.006, respectively). The most common type of leakage noted on CT was end plate (n = 81, 45%, 95% CI 38-52%), followed by paravertebral (n = 64, 35%, 95% CI 29-43%), epidural (n = 36, 20%, 95% CI 15-26%), and prevertebral venous (n = 32, 18%, 95% CI 13-24%). CONCLUSION Cement leakage after vertebroplasty is common and is often not reported by operators in procedural dictations. CT detects substantially more leaks than plain radiography.
Collapse
Affiliation(s)
| | | | - David F Kallmes
- College of Medicine
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
45
|
Wu CL, Wu JC, Huang WC, Wu HTH, Chiou HJ, Liu L, Chen YC, Chen TJ, Cheng H, Chang CY. The risk of stroke after percutaneous vertebroplasty for osteoporosis: a population-based cohort study. PLoS One 2012; 7:e31405. [PMID: 22303486 PMCID: PMC3269435 DOI: 10.1371/journal.pone.0031405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Accepted: 01/08/2012] [Indexed: 11/18/2022] Open
Abstract
Purpose To investigate the incidence and risk of stroke after percutaneous vertebroplasty in patients with osteoporosis. Methods A group of 334 patients with osteoporosis, and who underwent percutaneous vertebroplasty during the study period, was compared to 1,655 age-, sex- and propensity score-matched patients who did not undergo vertebroplasty. All demographic covariates and co-morbidities were deliberately matched between the two groups to avoid selection bias. Every subject was followed-up for up to five years for stroke. Adjustments using a Cox regression model and Kaplan-Meier analyses were conducted. Results A total of 1,989 osteoporotic patients were followed up for 3,760.13 person-years. Overall, the incidence rates of any stroke, hemorrhagic stroke and ischemic stroke were 22.6, 4.2 and 19.6 per 1,000 person-years, respectively. Patients who underwent vertebroplasty were not more likely to have any stroke (crude hazard ratio = 1.13, p = 0.693), hemorrhagic stroke (HR = 2.21, p = 0.170), or ischemic stroke (HR = 0.96, p = 0.90). After adjusting for demographics, co-morbidities and medications, the vertebroplasty group had no significant difference with the comparison group in terms of any, hemorrhagic and ischemic strokes (adjusted HR = 1.22, 3.17, and 0.96, p = 0.518, 0.055, and 0.91, respectively). Conclusions Osteoporotic patients who undergo percutaneous vertebroplasty are not at higher risk of any stroke in the next five years after the procedure.
Collapse
Affiliation(s)
- Ching-Lan Wu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jau-Ching Wu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan
| | - Wen-Cheng Huang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hung-Ta H. Wu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hong-Jen Chiou
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Laura Liu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Chun Chen
- Department of Medical Research and Education, National Yang-Ming University Hospital, I-Lan, Taiwan
- * E-mail:
| | - Tzeng-Ji Chen
- Institute of Hospital and Health Care Administration, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Henrich Cheng
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan
| | - Cheng-Yen Chang
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| |
Collapse
|