Pulmonary cement embolism is not associated with the cause of death in a post-mortem cohort of cement-augmented interventions in the spine

  • Sebastian Butscheidt
  • Tim Rolvien
  • Jakob Ritter
  • Axel Heinemann
  • Hermann Vogel
  • Michael Amling
  • Klaus Püschel
Original Article



Complications of cement-augmented interventions (e.g., kyphoplasty) in the spine include local cement leakage and pulmonary cement embolisms (PCE). This study was conducted to determine their extent in a unique post-mortem cohort.


Retrospective analysis of post-mortem whole-body CT scans and review of autopsy results in 29 consecutive cases with cement-augmented interventions in the spine. PCE findings were graded based on cement deposits: grade 0 (no PCE), grade 1 (1-3 PCE), grade 2 (4-6 PCE), and grade 3 (> 6 or branch-shaped PCE). Bone and lung tissue specimens were obtained in representative cases to confirm the findings histologically.


Local cement leakage was detected in 69%: intravenous (34%), intervertebral (31%), intraspinal (14%), and retrograde (17%). Lung sections showed PCE in 52%: grade 0 (48%), grade 1 (31%), grade 2 (10%), and grade 3 (10%). Matching with autopsy findings revealed that none of the cases died due to the impact of PCE.


The presented data reveal a high frequency of PCE making it a notable finding—especially since not only single but also branch-like embolisms were detected. Thus, it is of great importance that none of the causes of death were related to the impact of PCE. Nevertheless, it is crucial to consider the underlying diseases for increased PCE risk and to apply latest surgical techniques and preventive measures.

Graphical abstract

These slides can be retrieved under Electronic Supplementary material.


Pulmonary cement embolism PMMA Vertebroplasty Kyphoplasty Cause of death Histology 


Compliance with ethical standards

Conflict of interest

Sebastian Butscheidt, Tim Rolvien, Jakob Ritter, Axel Heinemann, Hermann Vogel, Michael Amling, and Klaus Püschel declare that they have no conflict of interest.

Supplementary material

586_2018_5581_MOESM1_ESM.pptx (3.7 mb)
Supplementary material 1 (PPTX 3745 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Sebastian Butscheidt
    • 1
  • Tim Rolvien
    • 1
  • Jakob Ritter
    • 2
  • Axel Heinemann
    • 2
  • Hermann Vogel
    • 2
  • Michael Amling
    • 1
  • Klaus Püschel
    • 2
  1. 1.Department of Osteology and BiomechanicsUniversity Medical Center Hamburg-EppendorfHamburgGermany
  2. 2.Department of Legal MedicineUniversity Medical Center Hamburg-EppendorfHamburgGermany

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