[Venous Paravasation After Augmentation of Pedicle Screws - An Underestimated Risk]

Cement-augmented pedicle screws can increase the stability of fixators for unstable vertebral fractures in the elderly. Fixators can be inserted quickly and with minimally invasive techniques, reducing surgical risks. From March 2012 until July 2014, we treated 40 patients with percutaneous augmented fixators for unstable vertebral fractures. Average age was 77.5 years. During the six month observation period, no patients died. There were no neurological deficits. On VAS, average pain decreased from 8.5 to 4.1 points postoperatively. The average Cobb angle of 4.1° was improved after surgery. After 6 months, bony consolidation yielded angles of 1 to 4°, average 2.6°. There was often venous extravasation of cement leaking from the augmented vertebrae, even extending to pulmonary embolism. The emboli were usually asymptomatic. We report a case where the patient required resuscitation immediately after cement application because of pulmonary emboli. The patient survived because of the immediately implemented critical care measures. Little has been published about this risk, which is underestimated despite increasing numbers of augmented fixator operations. The risk can be reduced with slower cement injection, smaller cement applicators, and short term positive pressure ventilation with PEEP.