Document Detail

Pulmonary cement embolism after augmentation of pedicle screws with bone cement.
MedLine Citation:
PMID:  20503956     Owner:  NLM     Status:  MEDLINE    
The authors present the very rare complication of widespread pulmonary artery cement embolism after pedicle screw augmentation with bone cement for multilevel spine fusion. A 69-year-old woman with severe osteoporosis underwent a posterior T12S1fusion because of lumbar scoliosis. After two months the superior pedicle screws loosened, and a revision spondylodesis T8L1 was performed with bone cement augmentation of the pedicle screws. Although cement leakage was seen paravertebrally, the patient was asymptomatic and reported distinct pain relief, so that no further investigations were initiated. Three months later, instability was identified in the adjacent superior segment. A CT-scan of the chest now revealed multiple pulmonary cement embolisms. Corpectomy T7 and extension spondylodesis T6T9 with an anterior single rod were performed. The pulmonary embolisms remained clinically silent and lung function was normal 18 months after surgery. The risk for cement embolism after pedicle screw augmentation has been established at 1/119 or 0.8%. After vertebroplasty and kyphoplasty it ranges from 3 to 23%. The existing literature offers no clear strategy for prevention or treatment of pulmonary cement embolism. The authors feel, as far as prevention is concerned, that creating a cavity by means of balloon distention before pedicle screw augmentation allows to inject the cement under lower pressure, so that the incidence of cement embolism might be reduced. Treatment options include, besides surgical removal in symptomatic embolism, heparin or warfarin treatment for 3 to 6 months.
Marc Röllinghoff; Jan Siewe; Peer Eysel; Karl-Stefan Delank
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Acta orthopaedica Belgica     Volume:  76     ISSN:  0001-6462     ISO Abbreviation:  Acta Orthop Belg     Publication Date:  2010 Apr 
Date Detail:
Created Date:  2010-05-27     Completed Date:  2010-07-06     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  2985165R     Medline TA:  Acta Orthop Belg     Country:  Belgium    
Other Details:
Languages:  eng     Pagination:  269-73     Citation Subset:  IM    
Department of Orthopaedic and Trauma Surgery, University of Cologne, Cologne, Germany.
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MeSH Terms
Bone Cements*
Bone Screws
Cementation / adverse effects*
Internal Fixators
Osteoporosis / complications
Pulmonary Embolism / etiology*
Scoliosis / surgery*
Spinal Fusion / adverse effects*,  methods
Spinal Stenosis / surgery
Vertebroplasty / adverse effects,  methods*
Reg. No./Substance:
0/Bone Cements

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