Management of pulmonary cement embolism after percutaneous vertebroplasty and kyphoplasty: a systematic review of the literature.
Balloon kyphoplasty and percutaneous vertebroplasty are relatively recent procedures in the treatment of painful vertebral fractures. There are, however, still some uncertainties about the incidence and treatment strategies of pulmonary cement embolisms (PCE). In order to work out a treatment strategy for the management of this complication, we performed a review of the literature. The results show that there is no clear diagnostic or treatment standard for PCE. The literature research revealed that the risk of a pulmonary embolism ranges from 3.5 to 23% for osteoporotic fractures. In cases of asymptomatic patients with peripheral PCE we recommend no treatment besides clinical follow-up; in cases of symptomatic or central embolisms, however, we recommend to proceed according to the guidelines regarding the treatment of thrombotic pulmonary embolisms, which includes initial heparinization and a following 6-month coumarin therapy. In order to avoid any types of embolisms, both procedures should only be performed by experienced surgeons after critical determination of the indications.
Krueger
Antonio
A
Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Giessen and Marburg, Baldingerstrasse, 35043, Marburg, Germany. akrueger@med.uni-marburg.de
Bliemel
Christopher
C
Zettl
Ralph
R
Ruchholtz
Steffen
S
D000925:Anticoagulants / Q000627:therapeutic use; D001843:Bone Cements / Q000009:adverse effects*; D006801:Humans; D010024:Osteoporosis / Q000150:complications; D018579:Patient Selection; D011183:Postoperative Complications / Q000139:chemically induced / Q000503:physiopathology / Q000628:therapy; D011655:Pulmonary Embolism / Q000139:chemically induced* / Q000188:drug therapy* / Q000503:physiopathology; D013121:Spinal Curvatures / Q000209:etiology / Q000517:prevention & control / Q000601:surgery*; D016103:Spinal Fractures / Q000150:complications / Q000601:surgery*; D054854:Vertebroplasty / Q000009:adverse effects* / Q000379:methods
D000925:Anticoagulants; D001843:Bone Cements