[Experiences with cement leakage after balloon kyphoplasty]

Area of Science:

• Interventional radiology
• Spinal surgery
• Medical imaging

Background:

• Kyphoplasty, a procedure for vertebral compression fractures, carries a risk of cement leakage.
• Extraspinal cement leakage can lead to serious vascular, cardiac, and pulmonary embolisms.
• While often asymptomatic, cement embolism is a potentially life-threatening complication.

Observation:

• A retrospective review of 46 kyphoplasty cases identified cement leakage in 17.4% of patients.
• Leakage into the vertebral venous plexus occurred in 8 cases, with 3 cases involving the inferior vena cava or azygos/hemiazygos veins.
• Pulmonary cement embolism was detected in cases where major venous vessels were involved.

Findings:

• Asymptomatic pulmonary cement embolism was observed in 3 out of 8 patients with major venous involvement.
• Endovascular extraction successfully removed intravasal cement fragments in two patients.
• No pulmonary embolism was detected in cases without major venous involvement.

Implications:

• Post-kyphoplasty computed tomography (CT) scans are recommended for all patients.
• CT chest imaging is advised for cases with inferior vena cava or azygos/hemiazygos vein involvement, even if asymptomatic.
• Endovascular techniques offer a safe and effective method for removing residual intravasal cement fragments.