Delayed presentation of pulmonary polymethylmethacrylate emboli after percutaneous vertebroplasty.
METHODS
Literature review concerning pulmonary embolism of polymethylmethacrylate (PMMA) material following percutaneous vertebroplasty and a report on 2 new cases.


OBJECTIVE
To inform clinicians about delayed clinical manifestation of pulmonary embolism of polymethylmethacrylate material after percutaneous vertebroplasty, pathophysiology, precautions, and therapeutic management of this complication.


BACKGROUND
Percutaneous vertebroplasty is a minimal invasive intervention used to treat vertebral fractures, which yields good therapeutic results and rarely produces complications. Nevertheless, serious complications may occur. Pulmonary PMMA embolism, which has been recently reported in some cases, is one of these.


RESULTS
We report on 2 cases of pulmonary embolism of PMMA material after percutaneous vertebroplasty. In the case of a 45-year-old female patient, symptoms of pulmonary embolism arose with a delay of 3 days following percutaneous vertebroplasty. A therapy with low-molecular-weight heparin, Enoxaparin, enabled recovery from pulmonary failure. The second case occurred without detection of any cement leakage into the paravertebral venous system, neither intraoperatively nor perioperatively. The existence of PMMA in pulmonary vessels was detected 1 year later and remained asymptomatic.


CONCLUSIONS
These 2 cases allow us to conclude that the risk of pulmonary embolism of PMMA might be underestimated. We propose routine chest radiograph following every vertebroplasty, in order to detect pulmonary PMMA embolism and thereby prevent serious delayed cardiopulmonary failures.
Abdul-Jalil
Youssef
Y
Department of Neurosurgery, Asklepios Klinik Schildautal Seesen, Germany. abdul-jalil@gmx.de
Bartels
Joerg
J
Alberti
Olaf
O
Becker
Ralf
R
D000925:Anticoagulants / Q000627:therapeutic use; D001843:Bone Cements / Q000009:adverse effects*; D017984:Enoxaparin / Q000627:therapeutic use; D005260:Female; D050815:Fractures, Compression / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects*; D019904:Polymethyl Methacrylate / Q000009:adverse effects*; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology*; D011859:Radiography; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
D000925:Anticoagulants; D001843:Bone Cements; D017984:Enoxaparin; D019904:Polymethyl Methacrylate