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Tsalimas G, Pappa E, Zygogiannis K, Antonopoulos S, Kakridonis F, Chatzikomninos I. Cement leakage and pulmonary embolism by bone cement-augmented pedicle screw fixation of the thoracolumbar spine - A case report. Surg Neurol Int 2024; 15:290. [PMID: 39246758 PMCID: PMC11380811 DOI: 10.25259/sni_506_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Accepted: 07/25/2024] [Indexed: 09/10/2024] Open
Abstract
Background Few studies discuss the complication of pulmonary cement embolism (PCE) due to cement augmented pedicle screw instrumentation (CAPSI) of the thoracolumbar spine. Case Description A 62 female with a history of multiple myeloma and Sjogren's syndrome on chronic steroids developed an osteoporotic L1 compression fracture and underwent posterior stabilization with a T10-L4 CAPSI. However, postoperatively, the patient developed a surgical site infection and a PCE, resulting in severe respiratory compromise and death 1 month later. Conclusion When performing a T10-L4 thoracolumbar CAPSI (i.e., augmented pedicle screw instrumentation of the thoracolumbar spine) to address an L1 osteoporotic compression fracture, a 62 year old patient developed a life ending multi organ deficiency due to sepsis together with a PCE.
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Affiliation(s)
- Georgios Tsalimas
- Department of Spine Surgery and Scoliosis, KAT General Hospital, Kifisia, Athens, Greece
| | - Eleni Pappa
- Department of Spine Surgery and Scoliosis, KAT General Hospital, Kifisia, Athens, Greece
| | | | - Spiridon Antonopoulos
- Department of Spine Surgery and Scoliosis, KAT General Hospital, Kifisia, Athens, Greece
| | - Fotios Kakridonis
- Department of Spine Surgery and Scoliosis, KAT General Hospital, Kifisia, Athens, Greece
| | - Ioannis Chatzikomninos
- Department of Spine Surgery and Scoliosis, KAT General Hospital, Kifisia, Athens, Greece
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Deng K, Yu JL, Feng YJ, Huang K, Wu GF. Case report: Inspiration from a rare fatal heart perforation after percutaneous vertebroplasty. Front Surg 2023; 10:1227056. [PMID: 37732163 PMCID: PMC10507243 DOI: 10.3389/fsurg.2023.1227056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/23/2023] [Indexed: 09/22/2023] Open
Abstract
The principal benefit of employing percutaneous vertebroplasty (PVP) for managing osteoporotic vertebral compression fractures lies in its capacity to facilitate early mobilization in elderly patients, thereby effectively avoiding the potential catastrophic complications associated with prolonged bedridden states. However, bone cement leakage, as the most common complication of PVP, may have fatal consequences. Here, we report a case involving an 85-year-old male patient with L1 vertebral compression fracture who underwent PVP at our hospital and was discharged on the same day of the surgical intervention. Subsequently, the patient experienced symptoms of chest tightness and palpitations. Cardiac ultrasound examination revealed pericardial effusion, while pulmonary computed tomographic angiography (CTA) demonstrated a strip high-density shadow in the right ventricular area. Finally, it was determined that the perforation of the right ventricular wall was caused by bone cement embolism. Through this comprehensive case report, we aim to deepen the understanding of orthopedic doctors on the importance of preventing bone cement leakage.
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Affiliation(s)
- Ke Deng
- Department of Orthopaedics, The First Affiliated Hospital of Yangtze University, Jingzhou, China
| | - Jia-Lin Yu
- Department of Orthopaedics, The First Affiliated Hospital of Yangtze University, Jingzhou, China
| | - Ye-Jun Feng
- Department of Orthopaedics, The First Affiliated Hospital of Yangtze University, Jingzhou, China
| | - Kui Huang
- Department of Orthopaedics, The First Affiliated Hospital of Yangtze University, Jingzhou, China
| | - Guo-Feng Wu
- Department of Orthopedics, South University of Science and Technology Hospital, Shenzhen, China
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Chang RY, Chen TH, Kuo CJ, Tsai HL. Intravascular Ultrasound and Multidetector Computed Tomography Imaging of Polymethylmethacrylate Cement Leakage Inducing Inferior Vena Cava Thrombosis. Circ Cardiovasc Imaging 2023; 16:e014527. [PMID: 36325903 DOI: 10.1161/circimaging.122.014527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Rei-Yeuh Chang
- Division of Cardiology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan (R.-Y.C., H.-L.T.).,Min-Hwei Junior College of Health Care Management, Tainan, Taiwan (R.-Y.C.)
| | - Tsung-Hsien Chen
- Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan (T.-H.C.)
| | - Chu-Jen Kuo
- Department of Radiology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan (C.-J.K.)
| | - Han-Lin Tsai
- Division of Cardiology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan (R.-Y.C., H.-L.T.)
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Yang KJ, Lee YP, Huang CH, Wang CH. Bone cement embolism into the right heart. JTCVS Tech 2022; 16:64-67. [PMID: 36510547 PMCID: PMC9735423 DOI: 10.1016/j.xjtc.2022.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/19/2022] [Accepted: 09/27/2022] [Indexed: 11/07/2022] Open
Affiliation(s)
- Kelvin Jeason Yang
- Department of Cardiovascular Surgery, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Ping Lee
- Department of Cardiovascular Surgery, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chi-Hsiang Huang
- Department of Anesthesiology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chih-Hsien Wang
- Department of Cardiovascular Surgery, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan,Address for reprints: Chih-Hsien Wang, MD, PhD, Department of Surgery, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7, Chung-Shan South Rd, Taipei 100, Taiwan.
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Huang C. Life-threatening intracardiac cement embolisms after percutaneous kyphoplasty: a case report and literature review. J Int Med Res 2022; 50:3000605221102088. [PMID: 35638519 PMCID: PMC9160901 DOI: 10.1177/03000605221102088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 05/04/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Percutaneous kyphoplasty is a popular technique in the treatment of osteoporotic vertebral fractures, but intracardiac cement embolism can be a life-threatening complication.Case presentation: The authors present a case involving a patient who developed dyspnea and chest tightness after percutaneous kyphoplasty. Echocardiography and chest computed tomography confirmed several foreign bodies in the right atrium and pulmonary arteries causing cardiac perforation and pericardial tamponade. Conservative treatment was administered, and the patient died of respiratory and heart failure. CONCLUSIONS The present case highlights that surgical removal may be the first-choice treatment for symptomatic intracardiac cement embolism.
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Affiliation(s)
- Chunneng Huang
- Department of Orthopedics, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine
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Sun K, Huang F, Liang B. A case report of intracardiac bone cement embolization after posterior decompression and cement-enhanced pedicle screw fixation for osteoporosis and lumbar degeneration. Medicine (Baltimore) 2022; 101:e28826. [PMID: 35212279 PMCID: PMC8878710 DOI: 10.1097/md.0000000000028826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 01/27/2022] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Bone cement leakage is a common complication of percutaneous kyphoplasty (PKP) and percutaneous vertebroplasty (PVP) surgery and has also been reported in posterior decompression and cement-enhanced pedicle screw fixation. When bone cement leaks through the venous system, it will have serious consequences and even endanger the life of the patient, especially when the bone cement causes intracardiac embolism. PATIENT CONCERNS A 70-year-old woman developed chest tightness and decreased blood oxygen saturation following posterior decompression and cement-enhanced pedicle screw fixation. DIAGNOSIS After the patient was given symptomatic treatment, the symptoms were not relieved, the high-sensitivity troponin I level continued to rise, the electrocardiogram results were abnormal, and chest computed tomography (CT) revealed multiple flaky and strip-shaped dense shadows in the heart. INTERVENTION The patient underwent removal of foreign bodies from the heart under cardiopulmonary bypass and tricuspid valvuloplasty, removal of intracardiac bone cement, and repair of the tricuspid valve and chordae. OUTCOME The patient recovered well postoperatively and was discharged from the hospital after 3 weeks. There were no intracardiac foreign bodies observed on chest CT after the operation. LESSONS For patients with cardiopulmonary discomfort after posterior decompression and bone cement-enhanced pedicle screw fixation, in view of the limitations of radiographic examination, we recommend performing chest CT examination to confirm the diagnosis. For patients with intravascular foreign body embolism, multidisciplinary team joint treatment saves lives.
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Affiliation(s)
- Kui Sun
- Department of Orthopedics, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan, Guangdong, China
| | - Fuli Huang
- Department of Orthopedics, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan, Guangdong, China
| | - Biru Liang
- Department of Spine Surgery, the Fifth Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
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Lambers M, Bruder O, Wieneke H, Nassenstein K. A spear to the heart-the accidental discovery of a giant cement embolism in the right heart: a case report. Eur Heart J Case Rep 2021; 5:ytab336. [PMID: 34859179 PMCID: PMC8633739 DOI: 10.1093/ehjcr/ytab336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/11/2021] [Accepted: 08/05/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND The incidence of recognized cardiopulmonary cement embolism in the context of percutaneous vertebroplasty varies between 0% and 23%. In most cases, only small fragments embolize in the pulmonary arteries or the right heart cavities. The latter can cause potential harm by right ventricular perforation. CASE SUMMARY A 57-year-old patient was admitted to our department of cardiology due to exertional dyspnoea and chest pain. In the course of further diagnostic tests, a huge cement embolus was accidentally discovered in the right ventricle. The unusual size and length and the threat of ventricular perforation make this case so unique. DISCUSSION Large cement embolisms in kyphoplasty settings are possible and associated with the risk of fulminant complications.
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Affiliation(s)
- Moritz Lambers
- Department of Cardiology and Angiology, Contilia Heart and Vascular Center, Elisabeth-Krankenhaus Essen, Klara-Kopp-Weg 1, 45138 Essen, Germany
| | - Oliver Bruder
- Department of Cardiology and Angiology, Contilia Heart and Vascular Center, Elisabeth-Krankenhaus Essen, Klara-Kopp-Weg 1, 45138 Essen, Germany
| | - Heinrich Wieneke
- Department of Cardiology and Angiology, Contilia Heart and Vascular Center, Elisabeth-Krankenhaus Essen, Klara-Kopp-Weg 1, 45138 Essen, Germany
| | - Kai Nassenstein
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
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Yin P, Hu J, Wang S, Sui G, Yuan G, Fan D. Bedside echocardiography for diagnosis of intracardiac cement embolism after percutaneous vertebroplasty: A case report. J Card Surg 2021; 36:3929-3932. [PMID: 34288121 DOI: 10.1111/jocs.15830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 07/10/2021] [Accepted: 07/10/2021] [Indexed: 11/27/2022]
Abstract
This case report is to demonstrate that a female patient had suddenly become unconscious 14 hours after percutaneous vertebroplasty. Bedside echocardiogram showed that the patient had a strong echo in the right heart with a small amount of pericardial effusion. CT showed high density in the distal branches of both pulmonary arteries and a high density in the right heart. With the help of that, the doctor made the diagnosis of intracardiac cement embolism in a very short time. The bone cement in the heart was removed under emergency cardiopulmonary bypass, then the patient was discharged smoothly.
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Affiliation(s)
- Panpan Yin
- Department of Ultrasound, The Affiliated Hospital of Jining Medical University, Jining, China
| | - Junli Hu
- Department of Ultrasound, The Affiliated Hospital of Jining Medical University, Jining, China
| | - Shaochun Wang
- Department of Ultrasound, The Affiliated Hospital of Jining Medical University, Jining, China
| | - Guiling Sui
- Department of Ultrasound, The Affiliated Hospital of Jining Medical University, Jining, China
| | - Guozhen Yuan
- Department of Ultrasound, The Affiliated Hospital of Jining Medical University, Jining, China
| | - Dongchen Fan
- Department of Ultrasound, The Affiliated Hospital of Jining Medical University, Jining, China
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Wang B, Li Y, Peng Y, Wu Y, Zhang L, Li H, Wang J, Xie M, Lv Q. Vertebroplasty and right heart cement embolism. QJM 2021; 114:124-126. [PMID: 33165615 DOI: 10.1093/qjmed/hcaa307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 10/23/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- B Wang
- From the Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Y Li
- From the Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Y Peng
- From the Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Y Wu
- From the Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - L Zhang
- From the Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - H Li
- From the Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - J Wang
- From the Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - M Xie
- From the Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Q Lv
- From the Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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Vasilikos I, Fistouris P, Krüger MT, Scholz C, Kogias E, Roelz R, Sircar R, Beck J, Hubbe U, Klingler JH. How Safe Is Minimally Invasive Transforaminal Lumbar Interbody Fusion for Octogenarians?: A Perioperative Complication Analysis. World Neurosurg 2020; 139:e754-e760. [DOI: 10.1016/j.wneu.2020.04.128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 10/24/2022]
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