Symptomatic pulmonary cement embolism following PMMA vertebroplasty: Clinical presentation and management

Vertebroplasty, a minimally invasive technique frequently used for spine stabilization and vertebral compression fractures, uses polymethylmethacrylate (PMMA) bone cement. Although usually benign, pulmonary cement embolism (PCE) is an uncommon but potentially dangerous consequence that arises when bone cement enters the pulmonary circulation through the vertebral venous system. Although the majority of PCE cases are underdiagnosed and asymptomatic, the incidence varies between 2.1 % and 26 % of vertebroplasty surgeries. To prevent incorrect diagnoses and needless treatments, early detection is essential.

We present the case of a 71-year-old woman with a history of type 2 diabetes mellitus and hypertension. She underwent laminectomy at the L3/4 and L4/5 levels in addition to PMMA cement-augmented intrapedicular fixation because of her severe spinal stenosis, hypertrophic facet joints, and instability. Three days following surgery, the patient had severe respiratory symptoms, including tachypnea, tachycardia, hypoxemia, and dyspnea. Additional oxygen was required due to oxygen desaturation. Non-contrast chest CT confirmed the presence of multiple bilateral high-density branching opacities in the pulmonary arteries that were compatible with PMMA emboli.

This example emphasizes how difficult it can be to diagnose symptomatic PCE after spinal instrumentation and how crucial it is to keep a high level of suspicion when patients arrive with unexplained respiratory symptoms after vertebroplasty. The preferred diagnostic method remains non-contrast chest CT, and the majority of symptomatic individuals can be conservatively treated with extra oxygen and anticoagulation when necessary.