Pulmonary cement embolism: a complication following vertebroplasty - a case report with brief review of literature

Background: A minimally invasive treatment for vertebral compression fractures is vertebroplasty. In spite of its relative safety, complications have been reported. It is a relatively uncommon complication among these that patients experience massive cement pulmonary embolism. Polymethyl methacrylate (PMMA) can cause embolization in the pulmonary arteries. One of the most common cements used in vertebroplasty is PMMA, a type of acrylic cement. Pulmonary cement embolism can occur if cement leaks into the perivertebral veins and then the pulmonary arteries (Barbero et al., Radiol Med 113:101–13, 2008). Occasionally, the patient will show no symptoms at all, while other times they will experience dyspnea, chest pain, or acute respiratory distress syndrome. A 54-year-old male who underwent vertebroplasty developed pulmonary cement embolism is the patient in our case report. Case presentation: A 54-year-old male had complaints of breathlessness for 1 week and left lower limb and lower back pain associated with swelling of the lower limbs for 20 days. The patient is an operated case of osteoporotic compression fractures of D6, D11, L1, L3, and L5 vertebroplasty 3 years back. Subsequently, computed tomography pulmonary angiography was performed and diagnosed with partial embolization of the distal peripheral branches of the bilateral pulmonary arteries by the vertebroplasty material. Conclusion: Vertebroplasty and kyphoplasty are the most prevalent procedures used to inject bone cement (PMMA) into the vertebral column in order to treat osteoporosis. With vertebroplasty, the possibility of embolization increases. In vertebral osteoporosis, the primary advantage is a reduction in pain and vertebral body collapse. Pulmonary cement embolization causes chest discomfort and shortness of breath. Sometimes, acute respiratory distress syndrome is present (Yoo et al., Spine (Phila Pa 1976) 29:E294–7, 2004). After the operation, these symptoms rarely arise. Symptoms often appear weeks, months, or years after the surgery (Habib et al., Heart Lung 41:509-11, 2012). Through this case report, we discuss the complication following vertebroplasty and their management guidelines.