Skip to main content
SpringerLink
Log in

Lungenembolie durch PMMA bei perkutaner Vertebroplastie

Fallbericht und Literaturübersicht

Pulmonary embolism caused by PMMA in percutaneous vertebroplasty

Case report and review of the literature

  • Kasuistik
  • Published:
Der Unfallchirurg Aims and scope Submit manuscript

Zusammenfassung

Wir berichten über eine 80-jährige Patientin mit absoluter Spinalkanalstenose infolge eines osteoporotisch bedingten Kollaps des LWK 1. Im Rahmen einer perkutan durchgeführten Wirbelkörperaugmentation kam es präoperativ zu einem perivertebralen Zementaustritt und anschließender PMMA-bedingter Lungenembolie.

Anhand der Literaturübersicht zu dieser seltenen Komplikation der Vertebroplastie wird die Häufigkeit des perivertebralen Zementaustritts bei derartigen Maßnahmen herausgestellt. Vor dem Hintergrund der hervorragenden konservativen Behandlungsergebnisse der osteoporotischen Wirbelkörperfrakturen ist vor dem Einsatz der Vertebroplastie eine strenge und individuelle Indikationsstellung hierzu erforderlich.

Abstract

We report on an 80-year-old female patient with osteoporotic collapse of the L1 vertebra who developed absolute stenosis of the spinal canal. During preoperative vertebra augmentation with PMMA (polymethylmethacrylate), pulmonary embolism developed due to perivertebral leakage of acrylic cement.

According to the literature, leakage of PMMA during (percutaneous) vertebroplasty is a more frequent complication than assumed so far. In view of the favorable prognosis of osteoporotic vertebral compression fractures with noninvasive management, we emphasize the need for clear and individual indications and adequate technical settings.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4

Literatur

  1. Aebli N, Krebs J, Davis G, Walton M, Williams MJ, Theis JC (2002) Fat embolism and acute hypotension during vertebroplasty: an experimental study in sheep. Spine 27: 460–466

    Article  PubMed  Google Scholar 

  2. Amar AP, Larsen DW, Esnaashari N, Albuquerque FC, Lavine SD, Teitelbaum GD (2001) Percutaneous transpedicular polymethyl-methacrylate vertebroplasty for the treatment of spinal cord compression fractures. Neurosurgery 5: 1105–1114

    Google Scholar 

  3. Belkoff SM, Mathis JM, Erbe EM, Fenton DC (2000) Biomechanical evaluation of a new bone cement for use in vertebroplasty. Spine 25: 1061–1064

    Article  CAS  PubMed  Google Scholar 

  4. Bernhard J, Heini PF, Villiger PM (2003) Asymptomatic diffuse pulmonary embolism caused by acrylic cement: an unusual complication of percutaneous vertebroplasty. Ann Rheum Dis 62: 85–86

    Article  CAS  PubMed  Google Scholar 

  5. Bostrom MPG, Lane JM (1997) Future directions. Augmentation of osteoporotic vertebral bodies. Spine 22: 38–42

    Article  PubMed  Google Scholar 

  6. Chen HL, Wong CS, Ho ST, Chang FL, Hsu CH, Wu CT (2002) A lethal pulmonary embolism during percutaneous vertebro-plasty. Anesth Analg 95: 1060–1062

    Google Scholar 

  7. Chiras J, Depriester C, Weill A, Sola-Martinez MT, Deramond H (1997) Percutaneous vertebral surgery. Technics and indications. J Neuroradiol 24: 45–59

    CAS  PubMed  Google Scholar 

  8. Dahl OE, Garvik LJ, Lyberg T (1994) Toxic effects of methyl-metacrylate monomer on leucocytes and endothelial cells in vitro. Acta Orthop Scand 65: 147–153

    CAS  PubMed  Google Scholar 

  9. Galibert P, Deramond H, Rosat P, Le Gars D (1987) Note preliminaire sur le traitment des angiomes vertebraux par vertebroplastie acrylique percutanee. Neurochirurgie 33: 166–168

    CAS  PubMed  Google Scholar 

  10. Jang JS, Lee SH, Jung SK (2002) Pulmonary embolism of polymethylmethacrylate after percutaneous vertebroplasty: a report of three cases. Spine 27: 416–418

    Article  Google Scholar 

  11. Jeffrey GJ, Kallmes DF, Mirza SK (2003) Vertebroplasty. Learning more, but not enough. Spine 28: 1487–1489

    Article  PubMed  Google Scholar 

  12. Kaufmann TJ, Jensen ME, Ford G, Gill LL, Marx WF, Kallmes DF (2002) Cardiovascular effects of polymethylmethacrylate use in percutaneous vertebroplasty. AJNR 23: 601–604

    Google Scholar 

  13. Lee BJ, Lee SR, Yoo TY (2002) Paraplegia as a complication of percutaneous vertebroplasty with polymethylmethacrylate. A case report. Spine 27: 419–422

    Article  Google Scholar 

  14. Martin JB, Jean B, Sugiu K et al. (1999) Vertebroplasty: clinical experience and follow-up results. Bone 25 (Suppl): 11–15

    Article  Google Scholar 

  15. Medicines and Healthcare products Regulatory Agency, Dept. Of Health, UK (2003) MDA/2003/021—Injectable polymeric cements used in percutaneous vertebroplasty, balloon kyphoplasty and pedicle screw augmentation. http://devices.mhra.gov.uk/mda/mdawebsitev2.nsf/webvwWhatsNew/ADC031554CA31DB880256D

  16. Podovani B, Kasriel O, Brunner P, Peretti-Viton P (1999) Pulmonary embolism caused by acrylic cement: a rare complication of percutaneous vertebroplasty. AJNR 20: 375–377

    CAS  Google Scholar 

  17. Ratliff J, Nguyen T, Heiss J (2001) Root and spinal cord compression from methylmethacrylate vertebroplasty. Spine 26: 300–301

    Article  Google Scholar 

  18. Scroop R, Eskridge J, Britz GW (2002) Paradoxical cerebral arterial embolization of cement during intraoperative vertebroplasty: case report. AJNR 23: 868–870

    Google Scholar 

  19. Shapiro S, Abel T, Purvines S (2003) Surgical removal of epidural and intradural polymethylmethacrylate extravasation complicating percutaneous vertebroplasty for an osteoporotic lumbar compression fracture. Case report. J Neurosurg 98 (Suppl 1): 90–92

    PubMed  Google Scholar 

  20. Tohmeh AG, Mathis JM, Fenton DC, Levine AM, Belkoff SM (1999) Biomechanical efficiacy of unipedicular versus bipedicular vertebroplasty for the management of osteoporotic compression fractures. Spine 24: 1772–1776

    Article  CAS  PubMed  Google Scholar 

  21. Tozzi P, Abdelmoumene Y, Corno AF, Gersbach PA, Hoogewoud HM, von Segesser LK (2002) Management of pulmonary embolism during acrylic vertebroplasty. Ann Thorac Surg 74: 1706–1708

    Article  PubMed  Google Scholar 

  22. Vasconcelos C, Gailloud NJ, Beauchamp NJ, Heck DV, Murphy KJ (2002) Is percutaneous vertebroplasty without pretreatment venography safe? Evaluation of 205 consecutive procedures. AJNR 23: 913–917

    Google Scholar 

  23. Vasconcelos C, Gailloud P, Martin JB, Murphy KJ (2001) Transient arterial hypotension induced by polymethylmethacrylate injection during percutaneous vertebroplasty. J Vasc Interv Radiol 12: 1001–1002

    CAS  PubMed  Google Scholar 

  24. Wenger M, Markwalder TM (2000) Letters to the editor. Re: Percutaneous vertebroplasty for pain relief and spinal stabilisation. Spine 25: 923–928

    CAS  PubMed  Google Scholar 

  25. Yeom JS, Kim WJ, Choy WS, Lee CK, Chang BS, Kang JW (2003) Leakage of cement in percutaneous transpedicular vertebroplasty for painful osteoporotic compression fractures. J Bone Joint Surg Br 85: 83–89

    Article  CAS  PubMed  Google Scholar 

Download references

Interessenkonflikt:

Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen.

Author information

Authors and Affiliations

  1. Unfallchirurgisch-Orthopädische Klinik, Klinikum Fulda

    M. Pleser, R. Roth & O. Wörsdörfer

  2. Klinik für Diagnostische und Interventionelle Radiologie, Klinikum Fulda,

    C. Manke

  3. Unfallchirurgisch-Orthopädische Klinik, Klinikum Fulda, Pacelliallee 4, 36043, Fulda

    M. Pleser

Authors
  1. M. Pleser
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. Roth
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. O. Wörsdörfer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C. Manke
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Pleser.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pleser, M., Roth, R., Wörsdörfer, O. et al. Lungenembolie durch PMMA bei perkutaner Vertebroplastie. Unfallchirurg 107, 807–811 (2004). https://doi.org/10.1007/s00113-004-0763-5

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00113-004-0763-5

Schlüsselwöter

Keywords

Search

Navigation