Intracardiac bone cement embolism and cardiac injury: a systematic review of 116 reported cases

Intracardiac bone cement embolism (BCE) is a rare but potentially serious complication of spinal augmentation. Clinical awareness remains limited because these events occur at the interface of spine and cardiothoracic specialties. This study synthesizes a collection of strictly intracardiac BCE cases to describe reported clinical features, injury patterns, and management strategies.

A systematic search of PubMed, Embase, and Cochrane (from inception through 2025) identified 116 unique cases after a two-tier adjudication process to eliminate duplicates. Reporting quality was assessed using a modified Joanna Briggs Institute checklist.

The median patient age was 69 years, and 75.9% were female. Most embolic events followed vertebroplasty (67.2%) or kyphoplasty (26.7%). Chest pain (59.5%) and dyspnea (54.3%) were the most common symptoms. Diagnostic yield was high for echocardiography (96.0%) and computed tomography (CT) (93.8%) but lower for chest X-ray (63.4%). Linear cement fragments were frequently associated with perforation (46.6%), most often involving the right ventricle (70.9%). Surgical retrieval was reported in 65.5% of cases, with concomitant structural repair in 19.2%. No deaths were attributable to surgical retrieval, whereas delayed diagnosis or treatment refusal led to fatal outcomes.

Published reports suggest that intracardiac BCE may behave as a mechanically hazardous condition with a substantial risk of perforation. The recurring patterns observed across studies highlight the importance of timely recognition and careful management. These descriptive findings may help inform clinical awareness and generate hypotheses for future investigation.