Presentation and management of symptomatic central bone cement embolization

Area of Science:

• Interventional Radiology
• Cardiothoracic Surgery
• Pulmonary Medicine

Background:

• Cement augmentation procedures, like vertebroplasty, are increasing, leading to a rise in serious complications.
• Symptomatic central cement embolization is a rare but severe complication with controversial pathophysiology and treatment.
• Intrathoracic cement embolism poses significant diagnostic and therapeutic challenges.

Purpose of the Study:

• To identify the varied presentations of symptomatic central cement embolization.
• To propose an emergent management strategy for this critical complication.
• To enhance awareness among healthcare providers regarding this rare entity.

Main Methods:

• Retrospective case series of nine patients diagnosed with symptomatic central cement embolism post-vertebroplasty.
• Patients underwent evaluation including chest X-ray, echocardiography, and high-resolution CT.
• Management strategies included emergent heart surgery, interventional therapy, or conservative treatment with anticoagulation, decided in interdisciplinary meetings.

Main Results:

• All nine patients demonstrated gradual improvement with an uneventful hospital stay.
• Eight patients had no recurrence of cardiological or respiratory symptoms at 24-month follow-up.
• One mortality occurred, attributed to advanced malignancy; preoperative anemia was a common preoperative factor.

Conclusions:

• Close clinical monitoring is essential after cement augmentation procedures.
• Chest CT is crucial for guiding interdisciplinary management decisions based on emboli location and accessibility.
• Widespread awareness among spine surgeons, emergency physicians, and nurses is vital for timely diagnosis and management, with conservative treatment often being effective.