Pulmonary cement embolism is not associated with the cause of death in a post-mortem cohort of cement-augmented interventions in the spine
Complications of cement-augmented interventions (e.g., kyphoplasty) in the spine include local cement leakage and pulmonary cement embolisms (PCE). This study was conducted to determine their extent in a unique post-mortem cohort.
Retrospective analysis of post-mortem whole-body CT scans and review of autopsy results in 29 consecutive cases with cement-augmented interventions in the spine. PCE findings were graded based on cement deposits: grade 0 (no PCE), grade 1 (1-3 PCE), grade 2 (4-6 PCE), and grade 3 (> 6 or branch-shaped PCE). Bone and lung tissue specimens were obtained in representative cases to confirm the findings histologically.
Local cement leakage was detected in 69%: intravenous (34%), intervertebral (31%), intraspinal (14%), and retrograde (17%). Lung sections showed PCE in 52%: grade 0 (48%), grade 1 (31%), grade 2 (10%), and grade 3 (10%). Matching with autopsy findings revealed that none of the cases died due to the impact of PCE.
The presented data reveal a high frequency of PCE making it a notable finding—especially since not only single but also branch-like embolisms were detected. Thus, it is of great importance that none of the causes of death were related to the impact of PCE. Nevertheless, it is crucial to consider the underlying diseases for increased PCE risk and to apply latest surgical techniques and preventive measures.
KeywordsPulmonary cement embolism PMMA Vertebroplasty Kyphoplasty Cause of death Histology
Compliance with ethical standards
Conflict of interest
Sebastian Butscheidt, Tim Rolvien, Jakob Ritter, Axel Heinemann, Hermann Vogel, Michael Amling, and Klaus Püschel declare that they have no conflict of interest.
- 7.Kim YJ, Lee JW, Park KW, Yeom JS, Jeong HS, Park JM, Kang HS (2009) Pulmonary cement embolism after percutaneous vertebroplasty in osteoporotic vertebral compression fractures: incidence, characteristics, and risk factors. Radiology 251(1):250–259. https://doi.org/10.1148/radiol.2511080854 CrossRefPubMedGoogle Scholar
- 9.Francois K, Taeymans Y, Poffyn B, Van Nooten G (2003) Successful management of a large pulmonary cement embolus after percutaneous vertebroplasty: a case report. Spine (Phila Pa 1976) 28(20):E424–E425. https://doi.org/10.1097/01.brs.0000092345.00563.e0 CrossRefGoogle Scholar
- 11.Oh JK, Park JH, Kim SS, Han JH, Kwon HJ, Kim JH, Lee JH, Choi SW, Jeong JO, Seong IW (2015) Thread-like bone cement in the right-side heart and pulmonary arteries causing diffuse pulmonary embolism as a late complication. Heart Lung Circ 24(7):e104–e107. https://doi.org/10.1016/j.hlc.2015.02.017 CrossRefPubMedGoogle Scholar
- 15.Cotten A, Dewatre F, Cortet B, Assaker R, Leblond D, Duquesnoy B, Chastanet P, Clarisse J (1996) Percutaneous vertebroplasty for osteolytic metastases and myeloma: effects of the percentage of lesion filling and the leakage of methyl methacrylate at clinical follow-up. Radiology 200(2):525–530. https://doi.org/10.1148/radiology.200.2.8685351 CrossRefPubMedGoogle Scholar
- 20.Amis ES Jr, Butler PF, Applegate KE, Birnbaum SB, Brateman LF, Hevezi JM, Mettler FA, Morin RL, Pentecost MJ, Smith GG, Strauss KJ, Zeman RK (2007) American college of radiology white paper on radiation dose in medicine. J Am Coll Radiol 4(5):272–284. https://doi.org/10.1016/j.jacr.2007.03.002 CrossRefPubMedGoogle Scholar