Thorned heart. Description of a near-fatal cardiac embolism after percutaneous vertebroplasty

Submitted: 6 December 2019
Accepted: 26 March 2020
Published: 6 May 2020
Abstract Views: 725
PDF: 319
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Authors

Cement extravasation is a rather common complication of vertebroplasty, which can be observed in up to 30-40% of patients undergoing this procedure, further associated with venous leakage occurring in up to 24% of cases. Pulmonary embolism may eventually develop once the cement migrates within the pulmonary artery, and is the most common complication of cement extravasation (involving ~4.6% of patients). Intra-cardiac cement embolism is considerably less frequent, but is a potentially fatal complication, mostly managed with cardiac surgery. We describe here a rare case of near-fatal cardiac cement embolism, with a large fragment perforating the right ventricle and reaching the pericardium, who presented to the Emergency Department (ED) for syncope. The patient, who displayed this severe complication after a vertebroplasty procedure performed for osteoporotic compression fracture, needed cardiac surgery.

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Citations

Gailbert P, Deramond H, Rosat P, et al. Preliminary note on the treatment of vertebral angioma by percutaneous vertebroplasty. Neurochirurgie 1987;2:166-168
Mazumdar A, Gilula LA. Relief of radicular pain in methastatic disease by vertebroplasty. Acta Radiologica 2010;51:179-182 DOI: https://doi.org/10.3109/02841850903431148
Chen LH, Hsieh MK, Niu CC, et al. Percutaneous vertebroplasty for pathological vertebral compression fractures secondary to multiple myeloma. Arch Orthop Trauma Surg 2012;132:1669-1670 DOI: https://doi.org/10.1007/s00402-012-1474-y
Buchbinder R, Osborne RH, Ebeling PR, et al. A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures. N Engl J Med 2009;361:557-568 DOI: https://doi.org/10.1056/NEJMoa0900429
Kallmes DF, Comstock BA, Heagerty PJ, et al. A randomized trial of vertebroplasty for osteoporotic spinal fractures. N Engl J Med 2009;361:569-579 DOI: https://doi.org/10.1056/NEJMoa0900563
Firanescu CE, de Vries J, Lodder P, et al. Vertebroplasty versus sham procedure for painful acute osteoporotic vertebral compression fractures (VERTOS IV): randomised sham controlled clinical trial. BMJ 2018;361:k1551 DOI: https://doi.org/10.1136/bmj.k1551
Lou S, Shi X, Zhang X, et al. Percutaneous vertebroplasty versus non-operative treatment for osteoporotic vertebral compression fractures: a meta-analysis of randomized controlled trials. Osteop Int 2019 Aug 3. doi: 10.1007/s00198-019-05101-8. [Epub ahead of print] DOI: https://doi.org/10.1007/s00198-019-05101-8
Buchbinder R, Johnston RV, Rischin KJ, et al. Percutaneous vertebroplasty for osteoporotic vertebral compression fracture. Cochrane Database Syst Rev 2018 Nov 6;11:CD006349 DOI: https://doi.org/10.1002/14651858.CD006349.pub3
Clark W, Bird P, Gonski P, et al. Safety and efficacy of vertebroplasty for acute painful osteoporotic fractures (VAPOUR): a multicentre, randomised, double-blind, placebo-controlled trial. Lancet 2016;388:1408-1416 DOI: https://doi.org/10.1016/S0140-6736(16)31341-1
Carragee EG. The vertebroplasty affair: the mysterious case of the disappearing effect size. Spine J 2010;10:191-192 DOI: https://doi.org/10.1016/j.spinee.2010.01.002
Wulff KC, Miller FG, Pearson SD. Can coverage be rescinded when negative trial results threaten a popular procedure? The ongoing saga of vertebroplasty. Health Aff (Millwood) 2011;30:2269-2276 DOI: https://doi.org/10.1377/hlthaff.2011.0159
Luetmer MT, Bartholmai BJ, Rad AE, et al. Asymptomatic and unrecognized cement pulmonary embolism commonly occurs with vertebroplasty. Am J Neuroradiol 2011;32:654-657 DOI: https://doi.org/10.3174/ajnr.A2368
Kim YJ, Lee JW, Park KW, et al. Pulmonary cement embolism after percutaneous vertebroplasty in osteoporotic vertebral compression fractures: incidence, characteristics, and risk factors. Radiology 2009;251:250-259 DOI: https://doi.org/10.1148/radiol.2511080854
Audat ZA, Alfawareh MD, Darwish FT, et al. Intracardiac leakage of cement during kyphoplasty and vertebroplasty: a case report. Am J Case Rep 2016;17:326-330 DOI: https://doi.org/10.12659/AJCR.897719
Teng MM, Cheng H, Ho DM, et al. Intraspinal leakage of bone cement after vertebroplasty: a report of 3 cases, Am J Neuroradiol 2006;27:224-229
Harrington KD. Major neurological complications following percutaneous vertebroplasty with polymethylmethacrylate: a case report, J Bone Joint Surg Am 2001;83:1070-1073 DOI: https://doi.org/10.2106/00004623-200107000-00014
Alvarez L, Perez-Higueras A, Quinones D, et al. Vertebroplasty in the treatment of vertebral tumors: postprocedural outcome and quality of life. Eur Spine J Section Cervical Spine Res Soc 2003;12:356–360 DOI: https://doi.org/10.1007/s00586-003-0525-z
Laredo JD, Hamze B. Complications of percutaneous vertebroplasty and their prevention. Skeletal Radiol 2004;33:493-505
Park JS, Kim J, Lee Y, et al. Intra-cardiac Embolism of a Large Bone Cement Material after Percutaneous Vertebroplasty Removed through a Combination of an Endovascular Procedure and an Inferior Vena Cava Exploration: a Case Report. J Korean Med Sci 2018;33:e141 DOI: https://doi.org/10.3346/jkms.2018.33.e141
Prokop A, Hägele M, Pfeilsticker U, et al. Pericardial perforation 2.5 years after kyphoplasty. A rare complication after cement extravasation. Unfallchirurg 2013;116:80-84 DOI: https://doi.org/10.1007/s00113-011-2136-1
Zhan Y, Jiang J, Liao H, Tan H, Yang K. Risk factors for cement leakage after vertebroplasty or kyphoplasty: a meta-analysis of published evidence. World Neurosurg 2017;101:633-642 DOI: https://doi.org/10.1016/j.wneu.2017.01.124
Janssen I, Ryang YM, Gempt J, et al. Risk of cement leakage and pulmonary embolism by bone cement-augmented pedicle screw fixation of the thoracolumbar spine. Spine J 2017;17:837-844 DOI: https://doi.org/10.1016/j.spinee.2017.01.009

How to Cite

Pigna, F., Calamai, S., Scioscioli, F., Buttarelli, L., Nicolini, F., & Cervellin, G. (2020). Thorned heart. Description of a near-fatal cardiac embolism after percutaneous vertebroplasty. Emergency Care Journal, 16(1). https://doi.org/10.4081/ecj.2020.8739