title: Inferior vena cava syndrome following percutaneous vertebroplasty with polymethylmethacrylate.
abstract: METHODS
  A case of inferior vena cava syndrome following percutaneous vertebroplasty is described herein.
  
  
  OBJECTIVE
  To alert clinicians to the potential occurrence of inferior vena cava syndrome following percutaneous vertebroplasty.
  
  
  BACKGROUND
  Vertebroplasty is a less invasive treatment solution for the osteoporotic compression fracture. There complications of the cement leakage would appear to have been rather infrequent. We report a case of inferior vena cava syndrome related to the cement leakage.
  
  
  METHODS
  A 59-year-old woman underwent percutaneous vertebroplasty for painful T11, L1, L2, and L3 compression fractures, under general anesthesia at a community hospital. A contralateral transpedicular approach was made in order to inject polymethylmethacrylate resin into the fractured vertebra.
  
  
  RESULTS
  Just subsequent to surgery, this patient developed dyspnea, arthralgia, myalgia, and progressive right lower-limb pain, redness, and swelling., conservative treatment being then undertaken, albeit in vain. One week after the attempted remediation of this patient's condition, she was transferred to our hospital for further management. After admission, radiography of the patient's lumbar spine (lateral view) revealed multiple cement leakage in the area of the posterior longitudinal ligament and also in the anterior paravertebral area. The abdominal and pelvic CT scan and venography revealed vertebroplasty cement leakage into the lumbar vein, the left renal vein, and the inferior vena cava. Thrombosis at the left common iliac vein and left femoral vein were noted with extension into the inferior part of the inferior vena cava. Intravenous heparin was then administered to our patient for the ensuing 20 days, at which time heparin was replaced by warfarin, in order to attempt to prevent progressive venous thrombosis. The patient's leg edema appeared to improve 10 weeks subsequent to her surgery, she then being able to perambulate using a rigid walker.
  
  
  CONCLUSIONS
  This case illustrates the need for clinicians to be critically aware of the potential occurrence of inferior vena cava syndrome among patients who have undergone percutaneous vertebroplasty, especially when multiple levels of vertebra are injected as part of the vertebroplasty procedure.
authors.affiliation: Department of Orthopaedics, E-Dal Hospital/I-Shou University, Kaohsiung, Taiwan.
authors.forename: Feng-Chen
authors.initials: FC
authors.lastname: Kao
authors.forename: Yuan-Kun
authors.initials: YK
authors.lastname: Tu
authors.forename: Po-Liang
authors.initials: PL
authors.lastname: Lai
authors.forename: Shang-Won
authors.initials: SW
authors.lastname: Yu
authors.forename: Cheng-Yo
authors.initials: CY
authors.lastname: Yen
authors.forename: Ming-Chih
authors.initials: MC
authors.lastname: Chou
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D001843:Bone Cements / Q000009:adverse effects*; D005260:Female; D050815:Fractures, Compression / Q000000981:diagnostic imaging / Q000601:surgery*; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008875:Middle Aged; D010690:Phlebography; D019904:Polymethyl Methacrylate / Q000009:adverse effects*; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D013577:Syndrome; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology*; D054854:Vertebroplasty / Q000009:adverse effects*; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D001843:Bone Cements; D014859:Warfarin; D006493:Heparin; D019904:Polymethyl Methacrylate