19 Harley St, London, W1G 9QJ, UK

Intracardiac bone cement embolism as a complication of vertebroplasty: management strategy.

Intracardiac bone cement embolism as a complication of vertebroplasty: management strategy.

Eur Spine J. 2016 Aug 17;

Authors: Hatzantonis C, Czyz M, Pyzik R, Boszczyk BM

Abstract
BACKGROUND: Vertebroplasty carries multiple complications due to the leakage of polymethylmethacrylate (PMMA) into the venous system through the iliolumbar or epidural veins. The rate of venous cement complications may vary from 1 to 10 %, with cement extravasation into the venous system in 24 % of patients. Emboli may further migrate into the right heart chambers and pulmonary arteries. Patients may vary in presentation from asymptomatic or symptoms such as syncope to life-threatening complications.
CASE REPORT: We present a case of a 57-year-old lady diagnosed with osteoporosis who underwent a staged antero-posterior fixation with PMMA vertebroplasty of progressive thoraco-lumbar kyphosis caused by osteoporotic fractures to T12, L1 and L2 vertebral bodies. Four weeks after the operation, the patient developed symptoms of left-sided chest pain, tachycardia and tachypnea. CT pulmonary angiogram (CTPA) found a high-density material within the right atrium, whilst ECHO demonstrated normal systolic function. The patient was commenced on enoxaparin at therapeutic dose of 1.5 mg/kg for 3 months and remained asymptomatic. Follow-up ECHO found no change to the heart function and no blood clot on the PMMA embolus.
CONCLUSIONS: Factors influencing the decision about conservative treatment included symptoms, localisation of the embolus, as well as time lapse between vertebroplasty and clinical manifestation. Patients that are commonly asymptomatic can be treated conservatively. The management of choice is anticoagulation with low-molecular-weight heparin or warfarin until the foreign body epithelialises and ceases in becoming potentially thrombogenic. Symptomatic patients with thrombi in the right atrium are commonly managed via percutaneous retrieval, whilst those with RV involvement or perforation are commonly managed with surgical retrieval. Management of individual patients should be based on individual clinical circumstances. Patients presenting with intracardiac bone cement embolism related to spinal procedures require thorough clinical assessment, cardiology input, and if required, surgical intervention.

PMID: 27535287 [PubMed – as supplied by publisher]

Intracardiac bone cement embolism as a complication of vertebroplasty management strategy | Total disc replacement using tissue-engineered intervertebral discs in the canine cervical spine

What our patients say ...

Consultant Spine Surgeon
Consultant Spine Surgeon
Consultant Spine Surgeon

Revolutionary Keyhole surgical technique to vaporise bulging discs

Laser Disc Surgery can be performed under local anaesthetic as a day case at our centre on the prestigious Harley Street.
Treatment of all spinal disorders

The London Spine Unit specialises in Minimally Invasive Treatments allowing rapid recovery and return to normal function.

UK's Leading Spine Surgeon

Mr Mo Akmal has developed revolutionary techniques to perform Day Case Spinal Surgery. We avoid traditional General Anaesthetic for all surgery.

Trusted by patients worldwide

The London Spine Unit provides the highest quality care to all patients and has VIP services for those seeking exceptional services.

If you have any emergency Doctor’s need, simply call our 24 hour emergency

Your personal case manager will ensure that you receive the best possible care.

Call Now 

+44 844 589 2020
+44 203 973 8810