General Spine

Hyung-Seok, Kim, M.D.
Jin-Hee, Park, M.D., Non ASSR Member
Sang-Ho, Lee, M.D., Non ASSR Member

Poster

Purpose

The purpose of this study is to present various central vascular cement embolisms after percutaneous vertebroplasty and to demonstrate the Multi-Detector Computed Tomography (MDCT) images of the embolic materials.

Methods & Materials

The wire-like polymethylmethacrylate (PMMA) materials in the central vascular system were detected on axial, sagittal, coronal and 3-D reconstructed 64-channel MDCT images in nine patients who underwent percutaneous vertebroplasty. We reviewed the patients profile, location and length of the PMMA emboli, and the origin of the emboli.

Results

Nine patients (M:F = 1:8, mean age, 66.6 years; range, 58-75) were included in this study. They had no specific symptoms related with complication of percutaneous vertebroplasty after the procedure. The mean symptom-free interval was 18.2 months (range, 1-84 months). There were two origins of the emboli in thoracic vertebra (one in T7 and another in T9) and seven of them in lumbar vertebra (one in L3, two in L4, and four in L5). The mean volume of injected PMMA was 3.9 cc (range, 2.5-5 cc). On MDCT images, the extended tip of the PMMA materials was located in inferior vena cava (IVC) in 7 patients, in left accessory hemiazygos vein in one patient, and over several areas which are superior vena cava (SVC), right atrium of the heart, and left pulmonary artery in one patient. The mean length of the PMMA embolic materials was 60.1 mm (range, 33-116 mm). On plain chest radiography, small PMMA particles were observed in two patients, multiple particles and the PMMA column in one patient, and no discrete PMMA materials in six patients.

Conclusion

Although the patients had no specific symptoms related to complication of percutaneous vertebroplasy, the cement emboli are located in many different sites, especially in the central vascular system, and have variable lengths, which could be well detected on MDCT images of the patients.

References/Financial Disclosures

1. Rebecca Scroop, Joseph Eskridge, Gavin W.Britz. Paradoxical cerebral arterial embolization of cement during intraoperative vertebroplasty: Case report. AJNR 2002;23:868-870
2. Bong-Jin Lee, Sung-Rak Lee, Tae-Yeol You. Paraplegia as a complication of percutaneous vertebroplasty with Polymethylmethacrylate, a case report. Spine 2002;27:E419-422
3. J Bernhard, P F Heini, P M Villiger. Asymptomatic diffuse pulmonary embolism caused by acrylic cement: an unusual complication of percutaneous vertebroplasty. Ann Rheum Dis 2003;62:85-86
4. John M. Mathis. Percutaneous vertebroplasty: Complication avoidance and technique optimization. AJNR 2003;24:1697-1706
5. Kyung Y Yoo, Seong W Jeong, Woong Yoon et al. Acute respiratory distress syndrome associated with pulmonary cement embolism following percutaneous vertebroplasty with polymethylmethacrylate. Spine 2004;29:E294-297
6. Du Hwan Choe, Edith M Marom, Kamran Ahrar et al. Pulmonary embolism of polymethylmethacrylate during percuteneous vertebroplasty and kyphoplasty. AJR 2004;183:1097-1102
7. Jason N MacTaggart, Iraklis I Piponos, Jason M Johanning et al. Acrylic cement pulmonary embolus masquerading as an embolized central venous catheter fragment. J of Vas Surg.2006;43:180-183
8. So Yeon Kim, Joon Beom Seo, Kyung-Hyun Do et al. Cardiac perforation caused by acrylic cement: a rare complication of percutaneos vertebroplasty. AJR 2005;185:1245-1247
9. A Baumann, J Tauss, G Baumann et al. Cement embolization into the vena cava and pulmonary arteries after vertebroplasty: interdisciplinary management. Eur K Vasc Endovasc Surg. 2006;31:558-561
10. Kyoung J Lim, Seung Z Yoon, Yun-Seok Jeon et al. An intraarterial thrombus and pulmonary thromboembolism as a late complication of percutaneus vertebroplasty. Intern Anesth Resarch Society 2007;104:924-926
11. Feng-Chen Kao, Yuan-Kun Tu, Po-Liang Lai et al. Inferior vena cava syndrome following percutaneous vertebroplasty with polymethylmethacrylate. Spine 2008;33:E329-333

Financial Discolosures:
I do not now have and have not within the past 12 months had a financial interest or other relationship as defined in paragraph two above with a commercial organization that may have an interest in the content of the educational activity.