Pulmonary embolism with polymethyl methacrylate (bone cement) after percutaneous vertebroplasty (a review of literature and case reports)
https://doi.org/10.18093/0869-0189-2019-29-3-353-359
Abstract
Percutaneous vertebroplasty (PVP) is a minimally invasive intervention widely used for relief of pain caused by osteoporotic, traumatic, or neoplastic vertebral fractures. During PVP, polymethyl methacrylate (bone cement) is injected directly into the vertebral body via a vertebral pedicle to partially restore the vertebral body height, to stabilize bone trabeculae and to alleviate pain. Though the procedure is minimally invasive, complications are not rare; however, mostly, they are not clinically significant. Potentially serious complications of PVP include pulmonary embolism with polymethyl methacrylate with variety of manifestations ranging from asymptomatic postoperative x-ray findings to life-threatening extravasation (cement "leakage") which is quite rare and fatal. Epidemiology, pathogenesis, clinical and radiological signs of pulmonary embolism in PVP and approaches to treatment are discussed in this review of literature. The article also describes two clinical cases of pulmonary embolism in patients underwent PVP for hemangioma of the vertebral body with severe pain syndrome are also described.
About the Authors
A. I. Sinopal’nikov
Russian Federal Academy of Continued Medical Education, Healthcare Ministry of Russia
Russian Federation
Russian Federation
Doctor of Medicine, Professor, Head of Department of Pulmonology,
ul. Barrikadnaya 2/1, Moscow, 123995
I. E. Tyurin
Russian Federal Academy of Continued Medical Education, Healthcare Ministry of Russia
Russian Federation
Russian Federation
Doctor of Medicine, Professor, Head of Department of Radiology,
ul. Barrikadnaya 2/1, Moscow, 123995
S. N. Shvayko
S.P.Botkin Moscow City Teaching Hospital, Moscow Healthcare Department
Russian Federation
Russian Federation
Candidate of Medicine, Head of Pulmonology Department,
Vtoroy Botkinskiy proyezd 5, Moscow, 125284
Zh. V. Sheykh
Russian Federal Academy of Continued Medical Education, Healthcare Ministry of Russia;
S.P.Botkin Moscow City Teaching Hospital, Moscow Healthcare Department
Russian Federation
Russian Federation
Doctor of Medicine, Professor, Department of Radiology, ul. Barrikadnaya 2/1, Moscow, 123995;
Head of Department of Computed Tomography, Vtoroy Botkinskiy proyezd 5, Moscow, 125284
L. V. Morozova
S.P.Botkin Moscow City Teaching Hospital, Moscow Healthcare Department
Russian Federation
Russian Federation
pulmonologist, Pulmonology Department,
Vtoroy Botkinskiy proyezd 5, Moscow, 125284
I. P. Smirnov
Russian Federal Academy of Continued Medical Education, Healthcare Ministry of Russia
Russian Federation
Russian Federation
Assistant Lecture, Department of Radiology,
ul. Barrikadnaya 2/1, Moscow, 123995
References
1. Hussain A., Erdek M. Vertebroplasty augmentation procedures: examining the controversy. Pain. Physician. 2013; 16 (5): E483–490.
2. Khosla A., Diehn F.E., Rad A.E., Kallmes D.F. Neither subendplate cement deposition nor cement leakage into the disk space during vertebroplasty significantly affects patient outcomes. Radiology. 2012; 264 (1): 180–186. DOI: 10. 1148/radiol.12112215.
3. Kotwica Z., Saracen A. Early and long-term outcomes of vertebroplasty for single osteoporotic fractures. Neurol. Neurochir. Pol. 2011; 45 (5): 431–435.
4. Liebschner M.A., Rosenberg W.S., Keaveny T.M. Effects of bone cement volume and distribution on vertebral stiffness after vertebroplasty. Spine. 2001; 26 (14): 1547–1554.
5. Saracen A., Kotwica Z. Treatment of multiple osteoporotic vertebral compression fractures by percutaneous cement augmentation. Int. Orthop. 2014; 38 (11): 2309–2312. DOI: 10.1007/s00264-014-2470-3.
6. Wu A.M., Chi Y.L., Ni W.F. Vertebral compression fracture with intervertebral vacuum cleft sign: pathogenesis, image, and surgical intervention. Asian. Spine. J. 2013; 7 (2): 148– 155. DOI: 10.4184/asj.2013.7.2.148.
7. Yokoyama K., Kawanishi M., Yamada M., et al. Safety and therapeutic efficacy of the second treatment for new fractures developed after initial vertebroplasty performed for painful vertebral compression fractures. Neurol. Res. 2013; 35 (6): 608–613. DOI: 10.1179/1743132813Y.0000000173.
8. Hao J., Hu Z. Percutaneous cement vertebroplasty in the treatment of symptomatic vertebral hemangiomas. Pain. Physician. 2012; 15 (1): 43–49.
9. Galibert P., Deramond H., Rosat P., Le Gars D. [Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty]. Neurochirurgie. 1987; 33 (2): 166–168 (in French).
10. Saracen A., Kotwica Z. Complications of percutaneous vertebroplasty. An analysis of 1 100 procedures performed in 616 patients. Medicine (Baltimore). 2016; 95 (24): e3850. DOI: 10.1097/MD.0000000000003850.
11. Lee I.J., Choi A.L., Yie M.Y. et al. CT evaluation of local leakage of bone cement after percutaneous kyphoplasty and vertebroplasty. Acta. Radiol. 2010; 51 (6): 649–654. DOI: 10.3109/02841851003620366.
12. Nieuwenhuijse M.J., van Erkel A.R., Dijkstra P.D. Cement leakage in percutaneous vertebroplasty for osteoporotic vertebral compression fractures: identification of risk factors. Spine. J. 2011; 11 (9): 839–848. DOI: 10.1016/j.spinee.2011. 07.027.
13. Kao F.C., Tu Y.K., Lai P.L. et al. Inferior vena cava syndrome following percutaneous vertebroplasty with polymethylmethacrylate. Spine. 2008; 33 (10): E329–333. DOI: 10.1097/BRS.0b013e31816f6a10.
14. Yang J.H., Kim J.W., Park H.O. et al. Intracardiac foreign body (bone cement) after percutaneous vertebroplasty. Korean. J. Thorac. Cardiovasc. Surg. 2013; 46 (1): 72–75. DOI: 10.5090/kjtcs.2013.46.1.72.
15. Chung S.E., Lee S.H., Kim T.H. et al. Renal cement embolism during percutaneous vertebroplasty. Eur. Spine. J. 2005; 15 (Suppl. 5): 590–594. DOI: 10.1007/s00586-005-0037-0.
16. Comstock B.A., Sitlani C.M., Jarvik J.G. et al. Investigational vertebroplasty safety and efficacy trial (INVEST): patient-reported outcomes trough 1 year. Radio logy. 2013; 269 (1): 224–231. DOI: 10.1148/radiol.1312 0821.
17. Abdelrahman H., Siam A.E., Shawky A. et al. Infection after vertebroplasty or kyphoplasty. A series of nine cases and review of literature. Spine. J. 2013; 13 (12): 1807–1809. DOI: 10.1016/j.spinee.2013.05.053.
18. Corcos G., Dbjay J., Mastier C., et al. Cement leakage in percutaneous vertebroplasty for spinal metastases: a retrospective evaluation of incidence and risk factors. Spine. 2014; 39 (5): E332–338. DOI: 10.1097/BRS.000000000000 0134.
19. Tomé-Bermejo F., Piñera A.R., Duran-Álvarez C. et al. Identification of risk factors for the occurrence of cement leakage during percutaneous vertebroplasty for painful osteoporotic or malignant vertebral fractures. Spine. 2014; 39 (11): E693–700. DOI: 10.1097/BRS.0000000000000294.
20. Parfenov V.E., Manukovskiy V.A., Kandyba D.V.et al. [Complications of percutaneous vertebroplasty]. Neyrokhirurgiya. 2008; (2): 48–53 (in Russian).
21. Milojkovic N., Homsi S. Polymethylmethacrylate pulmonary embolism as a complication of percutaneous vertebroplasty in cancer patients. J. Ark. Med. Soc. 2014; 111 (7): 140–142.
22. Wu Y.F., Lai C.C, Chao C.M. Severe pulmonary cement embolism. J. Emerg. Med. 2017; 53 (6): e139–140. DOI: 10. 1016/j.jemermed.2017.08.035.
23. Unal E., Balci S., Atceken Z. et al. Nonthrombotic pulmonary artery embolism: imaging findings and review of the literature. Am. J. Roentgenol. 2017; 208 (3): 505–516. DOI: 10.2214/AJR.16.17326.
24. Ignacio J.M.F., Ignacio K.H.D. Pulmonary embolism from cement augmentation of the vertebral body. Asian. Spine. J. 2018; 12 (2): 380–387. DOI: 10.4184/asj.2018.12.2.380.
25. El Saman A., Kelm A., Meier S. et al. Intraoperative PEEPventilation during PMMA-injection for augmented pedicle screws: improvement of leakage rate in spinal surgery. Eur .J. Trauma. Emerg. Surg. 2013; 39 (5): 461–468. DOI: 10.1007/s00068-013-0319-x.
26. Krueger A., Bliemel C., Zettl R., Ruchholtz S. Management of pulmonary cement embolism after percutaneous vertebroplasty and kyphoplasty: a systematic review of the literature. Eur. Spine. J. 2009; 18 (9): 1257–1265. DOI: 10.1007/s00586-009-1073-y.
27. Bliemel C., Buecking B., Struewer J. et al. Detection of pulmonary cement embolism after balloon kyphoplasty: should conventional radiographs become routine? Acts. Orthop. Belg. 2013; 79 (4): 444–450.
28. Venmans A., Klazen C.A., Lohle P.N. et al. Percutaneous vertebroplasty and pulmonary cement embolism: results from VERTOS II. Am. J. Neuroradiol. 2010; 31 (8): 1451– 1453. DOI: 10.3174/ajnr.A2127.
29. Luetmer M.T., Bartholmai B.J., Rad A.E., Kallmes D.F. Asymptomatic and unrecognized cement pulmonary embolism commonly occurs with vertebroplasty. Am. J. Neuroradiol. 2011; 32 (4): 654–657. DOI: 10.3174/ajnr.A2368.
30. Kim Y.J., Lee J.W., Park K.W. et al. Pulmonary cement embolism after percutaneous vertebroplasty in osteoporotic vertebral compression fractures: incidence, characteristics, and risk factors. Radiology. 2009; 251 (1): 250–259. DOI: 10.1148/radiol.2511080854.
31. Bopparaju S., Varon J., Surani S. Pulmonary embolism with vertebral augmentation procedures. Case Rep. Pulmonol. 2013; 2013: 785307. DOI: 10.1155/2013/785307.
32. Choe D.H., Marom E.M., Ahrar K. et al. Pulmonary embolism of polymethylmethacrylate during percutaneous vertebroplasty and kyphoplasty. Am. J. Roentgenol. 2004; 183 (4): 1097–1102. DOI: 10.2214/ajr.183.4.1831097.
33. Venmans A., Lole P.N., van Rooij W.J. et al. Frequency and outcome of pulmonary polymethylmethacrylate embolism during percutaneous vertebroplasty. Am. J. Neuroradiol. 2008; 29 (10): 1983–1985. DOI: 10.3174/ajnr.A1269.
34. Trumm C.G., Pahl A., Helmberger T.K. et al. CT fluoroscopy-guided percutaneous vertebroplasty in spinal malignancy: technical results, PMMA leakages, and complications in 202 patients. Skeletal. Radiol. 2012; 41 (11): 1391– 1400. DOI: 10.1007/s00256-012-1365-x.
35. Habib N., Maniatis T., Ahmed S. et al. Cement pulmonary embolism after percutaneous vertebroplasty and kyphoplasty: an overview. Heart Lung. 2012; 41 (5): 509–511. DOI: 10.1016/j.hrtlng.2012.02.008.
36. Percutaneous vertebroplasty for treatment of painful osteoporotic vertebral compression fractures: an evidence-based analysis. Ont. Health Technol. Assess. Ser. 2010; 10 (19): 1–45.
37. Wang L.J., Yang H.L., Shi Y.X. et al. Pulmonary cement embolism associated with percutaneous vertebroplasty or kyphoplasty: a systematic review. Orthop. Surg. 2012; 4 (3): 182–189. DOI: 10.1111/j.1757-7861.2012.00193.x.
38. Rothermich M.A., Buchowski J.M., Bumpass D.B., Patterson G.A. Pulmonary cement embolization after vertebroplasty requiring pulmonary wedge resection. Clin. Orthop. Relat. Res. 2014; 472 (5): 1652–1657. DOI: 10. 1007/s11999-014-3506-0.
39. Leitman D., Yu V., Cox C. Investigation of polymethylmethacrylate pulmonary embolism in patient ten years following vertebroplasty. J. Radiol. Case Rep. 2011; 5 (10): 14–21. DOI: 10.3941/jrcr.v5i10.815.
40. Sinha N., Padegal V., Satyanarayana S., Santosh H.K. Pulmonary cement embolization after vertebroplasty, an uncommon presentation of pulmonary embolism: a case report and literature review. Lung India. 2015; 32 (6): 602–605. DOI: 10.4103/0970-2113.168119.
41. Nooh A., Abduljabbar F.H., Abduljabbar A.H., Jarzem P. Pulmonary artery cement embolism after a vertebroplasty. Case Rep. Orthop. 2015; 2015: 582769. DOI: 10.1155/2015/582769.
42. Duran C., Sirvanci M., Aydoğan M. et al. Pulmonary cement embolism: a complication of percutaneous vertebroplasty. Acta Radiol. 2007; 48 (8): 854–859. DOI: 10.1080/02841850701422153.
43. Toru Ü., Coşkun T., Acat M. et al. Pulmonary cement embolism following percutaneous vertebroplasty. Case Rep. Pulmonol. 2014; 2014: 851573. DOI: 10.1155/2014/851573.
Review
For citations:
Sinopal’nikov A.I., Tyurin I.E., Shvayko S.N., Sheykh Zh.V., Morozova L.V., Smirnov I.P. Pulmonary embolism with polymethyl methacrylate (bone cement) after percutaneous vertebroplasty (a review of literature and case reports). PULMONOLOGIYA. 2019;29(3):353-359. (In Russ.) https://doi.org/10.18093/0869-0189-2019-29-3-353-359
Views:
1507
Email this article 