Percutaneous vertebroplasty and pulmonary cement embolism: results from VERTOS II.
OBJECTIVE
The reported incidence of PCE during PV varies, depending on the sensitivity of diagnostic tests used. To assess the true incidence of PCE, we performed native chest CT during follow-up in a large proportion of patients from the VERTOS II trial.


METHODS
VERTOS II is a prospective multicenter randomized controlled trial comparing PV with conservative therapy in 202 patients. After a mean follow-up of 22 months (median, 21 months; range, 6-42 months), 54 of 78 patients (69%) with 80 vertebrae treated with PV underwent native chest CT to detect possible PCE. The presence, location, number, and size of PCE were recorded. In addition, the presence of pulmonary parenchymal changes adjacent to PCE was noted. Possible risk factors for PCE, such as age, sex, number of treated vertebrae, cement volume per vertebra, and presence and location of perivertebral cement leakage, were evaluated.


RESULTS
PCE was detected in 14 of 54 patients (26% 95% CI, 16%-39%). All patients were asymptomatic. Cement emboli were small and randomly distributed in peripheral small vessels. There were no reactive pulmonary changes. Cement leakage in the azygos vein was the only risk factor for the occurrence of PCE (OR, 43; 95% CI, 5-396).


CONCLUSIONS
Small and clinically silent PCE occurred in a quarter of patients treated with PV. Cement leakage into the azygos vein was the only risk factor. With time, these small cement emboli remained inert, without inflammatory pulmonary response. Standard postprocedural CT or chest radiographs are not necessary.
Venmans
A
A
Department of Radiology, St.Elisabeth Ziekenhuis, Hilvarenbeekseweg 60, 5022 GC Tilburg, the Netherlands. alexandervenmans@hotmail.com
Klazen
C A H
CA
Lohle
P N M
PN
van Rooij
W J
WJ
Verhaar
H J J
HJ
de Vries
J
J
Mali
W P Th M
WP
D000368:Aged; D000369:Aged, 80 and over; D001401:Azygos Vein; D001843:Bone Cements / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D050815:Fractures, Compression / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000453:epidemiology / Q000628:therapy*; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors; D016103:Spinal Fractures / Q000453:epidemiology / Q000628:therapy*; D036542:Tomography, Spiral Computed; D054854:Vertebroplasty / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data
D001843:Bone Cements