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European Spine Journal

, Volume 27, Issue 10, pp 2584–2592 | Cite as

Presentation and management of symptomatic central bone cement embolization

  • Ahmed Samir BarakatEmail author
  • Tamer Owais
  • Mohamed Alhashash
  • Mootaz Shousha
  • Hesham El Saghir
  • Bernward Lauer
  • Heinrich Boehm
Original Article

Abstract

Background context

With more cement augmentation procedures done, the occurrence of serious complications is also expected to rise. Symptomatic central cement embolization is a rare but very serious complication. Moreover, the pathophysiology and treatment of intrathoracic cement embolism remain controversial.

Purpose

In this case series, we are trying to identify various presentations and suggest our emergent management scheme for symptomatic central cement embolization.

Patient sample

Retrospective case series of nine patients with symptomatic central cement embolism identified after vertebroplasty with 24 months of follow-up. Level IV.

Outcome measures

The degree of dyspnea measured by the New York Heart Association (NYHA) score and/or death related to cement embolism induced cardio/respiratory failure at the final follow-up at 24 months.

Methods

The nine patients, eight females, and one male had a mean age of 70.25 years (range 65–78 years) and were operated between January 2004 and December 2014. They had percutaneous vertebroplasty for osteoporotic non-traumatic and malignant vertebral collapse of dorsal and lumbar vertebrae. Post-vertebroplasty dyspnea and stitching chest pain were striking in the nine patients. After exclusion of cardiac ischemia and medical pulmonary causes for dyspnea, we identified radiopaque lesions on the chest X-ray. Further echocardiography and high-resolution chest CT were performed for optimal localization. Emergent heart surgery was performed in two patients: interventional therapy was conducted in one patient, while the remaining six patients were conservatively treated by anticoagulation. The management decision was taken in the setting of an interdisciplinary meeting depending on localization, fragmentation, and clinical status.

Results

All patients of this series showed gradual improvement and an uneventful hospital stay. During our 24-month follow-up phase, eight patients showed no subsequent cardiological and/or respiratory symptoms (NYHA I). However, one mortality due to advanced malignancy occurred. Preoperative anemia was the only common intersecting preoperative parameter among these nine patients.

Conclusions

After cement augmentation, close clinical monitoring is mandatory. A chest CT is pivotal in determining the interdisciplinary management approach in view of the availability of necessary expertise, facilities and the location of the cement emboli whether accessible by cardiac or vascular surgical means. The clinical presentation and its timing may vary and the patient may be seen subsequently by other health care providers obligating a wide-spread awareness for this serious entity among health care providers for this age group as spine surgeons, family and emergency room doctors, and institutional or home-care nurses. Most symptomatic central cement emboli may be treated conservatively.

Keywords

Vertebral cement leakage Pulmonary cement emboli and central symptomatic bone embolization Open heart and minimally invasive heart surgery Radiological interventionist Conservative treatment 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that there are no conflicts of interest regarding this work.

Funding

There is no private or public funding source regarding this work.

Human and animal rights statement

This article does not contain any studies with human participants or animals performed by any of the authors. The surgical, as well as the conservative treatment modalities described in this manuscript, are well established and profoundly documented elsewhere in the relevant literature.

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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  1. 1.Department of Spinal SurgeryZentralklinik Bad BerkaBad BerkaGermany
  2. 2.Department of Cardiac SurgeryZentralklinik Bad BerkaBad BerkaGermany
  3. 3.Department of CardiologyZentralklinik Bad BerkaBad BerkaGermany
  4. 4.Department of Orthopedics and Spinal SurgeryAlexandria University HospitalsAlexandriaEgypt
  5. 5.Department of Cardiothoracic SurgeryCairo UniversityCairoEgypt
  6. 6.Department of Orthopedics and TraumatologyCairo UniversityCairoEgypt

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