scholarly journals Asymptomatic Bone Cement Pulmonary Embolism after Vertebroplasty: Case Report and Literature Review

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Girolamo Geraci ◽  
Giorgio Lo Iacono ◽  
Chiara Lo Nigro ◽  
Fabio Cannizzaro ◽  
Massimo Cajozzo ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Case Report ◽  
Bone Cement ◽  
Percutaneous Vertebroplasty ◽  
Correct Diagnosis ◽  
Cement Leakage ◽  
Close Monitoring ◽  
Cement Embolism ◽  
Malignant Lesions ◽  
Vertebral Bodies

Introduction. Acrylic cement pulmonary embolism is a potentially serious complication following vertebroplasty.Case Report. A 70-year-old male patient was treated with percutaneous vertebroplasty for osteoporotic nontraumatic vertebral collapse of L5-S1. Asymptomatic pulmonary cement embolism was detected on routine postoperative chest radiogram and the patient was treated with enoxaparin, amoxicillin, and dexamethasone. At the followup CT scan no further migration of any cement material was reported; and the course was uneventful.Discussion. The frequency of local leakage of bone cement is relatively high (about 80–90%), moreover, the rate of cement leakage into the perivertebral veins (seen in up to 24% of vertebral bodies treated) with consequent pulmonary cement embolism varies from 4.6 to 6.8% (up to 26% in radiologic studies); the risk of embolism is increased with the liquid consistency of the cement and with the treatment of some malignant lesions. Patients may remain asymptomatic and develop no known long-term sequelae.Conclusions. Our ancedotal case illustrates the need for close monitoring of patients undergoing percutaneous vertebroplasty and emphasizes the importance of prompt and correct diagnosis and treatment, even if actually there is no agreement regarding the therapeutic strategy.

scholarly journals Percutaneous vertebroplasty versus kyphoplasty for the treatment of neurologically intact osteoporotic Kümmell’s disease

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shou-qian Dai ◽  
Rong-qing Qin ◽  
Xiu Shi ◽  
Hui-lin Yang
Keyword(s):  
Blood Loss ◽  
Bone Cement ◽  
Percutaneous Vertebroplasty ◽  
Cement Leakage ◽  
Intraoperative Blood Loss ◽  
Surgical Time ◽  
Significant Difference ◽  
Neurologically Intact ◽  
Operation Cost

Abstract Background Percutaneous vertebroplasty (PVP) and kyphoplasty (PKP) have been widely used to treat neurologically intact osteoporotic Kümmell’s disease (KD), but it is still unclear which treatment is more advantageous. Our study aimed to compare and investigate the safety and clinical efficacy of PVP and PKP in the treatment of KD. Methods The relevant data that 64 patients of neurologically intact osteoporotic KD receiving PVP (30 patients) or PKP (34 patients) were analyzed. Surgical time, operation costs, intraoperative blood loss, volume of bone cement injection, and fluoroscopy times were compared. Occurrence of cement leakage, transient fever and re-fracture were recorded. Universal indicators of visual analogue scale (VAS) and Oswestry disability index (ODI) were evaluated separately before surgery and at 1 day, 6 months, 1 year, 2 years and the final follow-up after operation. The height of anterior edge of the affected vertebra and the Cobb’s angle were assessed by imaging. Results All patients were followed up for at least 24 months. The volume of bone cement injection, intraoperative blood loss, occurrence of bone cement leakage, transient fever and re-fracture between two groups showed no significant difference. The surgical time, the operation cost and fluoroscopy times of the PKP group was significantly higher than that of the PVP group. The post-operative VAS, ODI scores, the height of the anterior edge of the injured vertebrae and kyphosis deformity were significantly improved in both groups compared with the pre-operation. The improvement of vertebral height and kyphosis deformity in PKP group was significantly better than that in the PVP group at every same time point during the follow-up periods, but the VAS and ODI scores between the two groups showed no significant difference. Conclusion PVP and PKP can both significantly alleviate the pain of patients with KD and obtain good clinical efficacy and safety. By contrast, PKP can achieve better imaging height and kyphosis correction, while PVP has the advantages of shorter operation time, less radiation volume and operation cost.

scholarly journals Effect of unilateral pulsed jet lavage prior to vertebroplasty on the intravertebral pressure and cement distribution

2020 ◽  
Author(s):  
Jun Yan ◽  
Qiaohui Liu ◽  
Yanping Zheng ◽  
Ziqun Liu ◽  
Xinyu Liu ◽  
...  
Keyword(s):  
Bone Cement ◽  
Lumbar Vertebrae ◽  
Compression Fracture ◽  
Cement Leakage ◽  
Control Group ◽  
Pulsed Jet ◽  
Jet Lavage ◽  
Average Maximum ◽  
Cement Distribution ◽  
Vertebral Bodies

Abstract Background: Percutaneous vertebroplasty is the most common treatment for osteoporotic vertebral compression fracture. However, the morbidity of vertebroplasty-related complications, such as cement leakage, remains high. We tested a new technique of unilateral pulsed jet lavage and investigated its effect on the intravertebral pressure and bone cement distribution. Methods: Thirty lumbar vertebrae (L1-L5) from six cadaver spines were randomly allocated into two groups (with and without irrigation). Prior to vertebroplasty, pulsed jet lavage was performed through one side of the pedicle by using a novel cannula with two concentric conduits to remove the fat and bone marrow of the vertebral bodies in the group with irrigation. The control group was not irrigated. Then, standardized vertebroplasty was performed in the vertebral bodies in both groups. Changes in the intravertebral pressure during injection were recorded. Computed tomography (CT) was performed to observe the cement distribution and extravasations, and the cement mass volume (CMV) was calculated. Results: During cement injection, the average maximum intravertebral pressure of the unirrigated group was higher than that of the irrigated group (4.92kPa versus 2.22kPa, P<0.05). CT scans showed a more homogeneous cement distribution with less CMV (3832 mm 3 vs. 4344 mm 3 , P<0.05) and less leakage rate (6.7% vs. 46.7%, P<0.05) in the irrigated group than in the control group. Conclusions: Unilateral pulsed jet lavage can reduce intravertebral pressure and lower the incidence of cement leakage during vertebroplasty. An enhanced bone cement distribution can also be achieved through this lavage system.

scholarly journals A case of multilevel percutaneous vertebroplasty for vertebral metastases resulting in temporary paraparesis

2019 ◽  
Vol 48 (2) ◽  
pp. 030006051983508
Author(s):  
Guan Shi ◽  
Fei Feng ◽  
Chen Hao ◽  
Jia Pu ◽  
Bao Li ◽  
...  
Keyword(s):  
Bone Cement ◽  
Percutaneous Vertebroplasty ◽  
Cement Leakage ◽  
Spinal Nerve ◽  
Vertebral Compression Fractures ◽  
Vertebral Metastases ◽  
Osteoporotic Vertebral Compression Fractures ◽  
Invasive Treatment ◽  
Compression Fractures ◽  
Cord Injury

Percutaneous vertebroplasty (PVP) is a minimally invasive treatment that has been widely used for the treatment of osteoporotic vertebral compression fractures and vertebral tumors. However, the maximum number of vertebral segments treated in a single PVP remains controversial. Furthermore, PVP may cause complications, including cement leakage, pulmonary embolism, bone cement toxicity, and spinal nerve-puncture injury. We report the rare case of a patient who underwent multilevel PVP for vertebral metastases, with no bone cement leakage or spinal cord injury, but who developed temporary paraparesis.

Risk of cement leakage and pulmonary embolism by bone cement-augmented pedicle screw fixation of the thoracolumbar spine

2017 ◽  
Vol 17 (6) ◽  
pp. 837-844 ◽  
Author(s):  
Insa Janssen ◽  
Yu-Mi Ryang ◽  
Jens Gempt ◽  
Stefanie Bette ◽  
Julia Gerhardt ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Bone Cement ◽  
Pedicle Screw ◽  
Screw Fixation ◽  
Thoracolumbar Spine ◽  
Cement Leakage ◽  
Pedicle Screw Fixation

scholarly journals Machine Learning Applications for the Prediction of Bone Cement Leakage in Percutaneous Vertebroplasty

2021 ◽  
Vol 9 ◽  
Author(s):  
Wenle Li ◽  
Jiaming Wang ◽  
Wencai Liu ◽  
Chan Xu ◽  
Wanying Li ◽  
...  
Keyword(s):  
Machine Learning ◽  
Logistic Regression ◽  
Bone Cement ◽  
Percutaneous Vertebroplasty ◽  
Cement Leakage ◽  
Gradient Boosting ◽  
Vertebral Compression Fractures ◽  
Good Prediction ◽  
Extreme Gradient Boosting ◽  
The Web

Background: Bone cement leakage is a common complication of percutaneous vertebroplasty and it could be life-threatening to some extent. The aim of this study was to develop a machine learning model for predicting the risk of cement leakage in patients with osteoporotic vertebral compression fractures undergoing percutaneous vertebroplasty. Furthermore, we developed an online calculator for clinical application.Methods: This was a retrospective study including 385 patients, who had osteoporotic vertebral compression fracture disease and underwent surgery at the Department of Spine Surgery, Liuzhou People's Hospital from June 2016 to June 2018. Combing the patient's clinical characteristics variables, we applied six machine learning (ML) algorithms to develop the predictive models, including logistic regression (LR), Gradient boosting machine (GBM), Extreme gradient boosting (XGB), Random Forest (RF), Decision Tree (DT) and Multilayer perceptron (MLP), which could predict the risk of bone cement leakage. We tested the results with ten-fold cross-validation, which calculated the Area Under Curve (AUC) of the six models and selected the model with the highest AUC as the excellent performing model to build the web calculator.Results: The results showed that Injection volume of bone cement, Surgery time and Multiple vertebral fracture were all independent predictors of bone cement leakage by using multivariate logistic regression analysis in the 385 observation subjects. Furthermore, Heatmap revealed the relative proportions of the 15 clinical variables. In bone cement leakage prediction, the AUC of the six ML algorithms ranged from 0.633 to 0.898, while the RF model had an AUC of 0.898 and was used as the best performing ML Web calculator (https://share.streamlit.io/liuwencai0/pvp_leakage/main/pvp_leakage) was developed to estimate the risk of bone cement leakage that each patient undergoing vertebroplasty.Conclusion: It achieved a good prediction for the occurrence of bone cement leakage with our ML model. The Web calculator concluded based on RF model can help orthopedist to make more individual and rational clinical strategies.

scholarly journals Successful surgical treatment of intracardiac bone cement embolism after vertebroplasty of the L2 vertebral body

2020 ◽  
Vol 8 (4S) ◽  
pp. 130-134
Author(s):  
N. I. Zagorodnikov ◽  
I. K. Halivopulo ◽  
A. V. Sotnikov ◽  
E. I. Ardasheva
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Surgical Treatment ◽  
Bone Cement ◽  
Vertebral Body ◽  
Percutaneous Vertebroplasty ◽  
Treatment Options ◽  
Cord Injury ◽  
Cement Embolism ◽  
Bone Cement Embolism

Percutaneous Vertebroplasty (PVP) is the minimally invasive radiological procedure consisting in the transdermal injection of bone cement into the damaged vertebral body. PVP performing has a high risk of complications including vascular embolism which has value from 3.5 to 30 %. There is an example of cardioembolism with bone cement as a result of PVP complication after surgical treatment of a patient with a spinal cord injury after ancar accident and the successful extraction of this embolus is given in this clinical case.The authors describe the approaches to this problem, including the diagnosis of the condition and treatment options.

scholarly journals Symptomatic pulmonary cement embolism after pedicle screw polymethylmethacrylate cement augmentation: A case report and review

2020 ◽  
Vol 11 ◽  
pp. 18 ◽  
Author(s):  
Abolfazl Rahimizadeh ◽  
Valiollah Hassani ◽  
Housain Soufiani ◽  
Ava Rahimizadeh ◽  
Mona Karimi ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Pedicle Screw ◽  
Rare Complication ◽  
Cement Leakage ◽  
Cement Augmentation ◽  
Case Description ◽  
Pedicle Screw Placement ◽  
Failed Back Syndrome ◽  
High Incidence ◽  
Cement Embolism

Background: In osteoporotic patients, a useful technique for significantly enhancing the strength of a pedicle screw is augmentation with polymethylmethacrylate cement. However, a rare complication of this procedure is a symptomatic pulmonary cement embolism. Case Description: A pedicle screw cement augmentation was performed in a middle-aged female for the failed back syndrome. When she developed symptomatic pulmonary cement emboli, she was successfully managed with conservative measures, including anticoagulation. Conclusion: Despite the increased use of cement augmentation for pedicle screw placement and the relatively high incidence of cement leakage into the prevertebral venous system, symptomatic cement pulmonary embolism remains rare. The management of such symptomatic CPE should be evaluated and treated based on both the size and location of the embolism. Here, we presented this case while reviewing three symptomatic and four asymptomatic cases from the literature.

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