Polymethylmethacrylate Pulmonary Embolism Following Vertebroplasty

Area of Science:

• Spinal Surgery
• Interventional Radiology
• Pulmonary Medicine

Background:

• Polymethylmethacrylate (PMMA) is widely used in vertebroplasty for vertebral body stabilization, particularly in osteoporosis.
• Increasing use of vertebroplasty has led to a rise in PMMA pulmonary embolism, a potentially lethal complication.
• Current management algorithms for PMMA embolism are not well-established, leading to diagnostic and therapeutic controversies.

Observation:

• A case of delayed diagnosis of PMMA pulmonary embolism following percutaneous vertebroplasty for an osteoporotic fracture is presented.
• The patient experienced recurrent chest discomfort and cough, initially managed conservatively after delayed diagnosis via cross-sectional imaging.
• Despite the delay, the patient achieved a positive outcome with no long-term morbidity.

Findings:

• PMMA extravasation into vasculature can lead to pulmonary embolism, ranging from mild to severe.
• Delayed diagnosis can occur despite initial presentation to emergency departments for related symptoms.
• Conservative management may be effective in resolving acute symptoms of PMMA embolism.

Implications:

• This case underscores the need for increased awareness and timely diagnosis of PMMA pulmonary embolism.
• Further research is needed to establish clear diagnostic and management guidelines for PMMA embolism.
• Evaluating the impact of earlier diagnosis on patient outcomes is crucial for refining treatment strategies.