A new study published in the Journal of Orthopaedic Surgery and Research evaluated risk factors, incidence and clinical management of pulmonary cement embolism and neurological deficit during percutaneous vertebroplasty (PVP).

This retrospective study reviewed 3 175 patients with symptomatic osteoporotic vertebral compression fractures (OVCFs), who had been treated with PVP in an institution. Image and surgical parameters including the amount of cement, the vertebral level, uni- or bipedicle surgical approach and leakage pattern were recorded.

The findings revealed that type-C leakage, including paraspinal (25%), intradiscal (26%) and posterior (0.7%) leakage, were more common than type-B (11.4%) and type-S leaks (4.9%). Cement leakage into the spinal canal (type-C posterior) occurred in 26 patients (0.7%), while four patients needed surgical decompression. In addition, three out of nine patients with leakage into thoracic spine needed decompressive surgery, but only one of 17 patients into lumbar spine needed surgery. On the other hand, age, gender, number of fractures and time from fracture to vertebroplasty were not risk factors of pulmonary cement embolism or neurological deficit. The risk factor of pulmonary cement embolism was higher volume of polymethylmethacrylate (PMMA) injected and risk factor of neurological deficit was type-C posterior cement leakage into the thoracic spine. Moreover, the incidence of pulmonary cement embolism was significantly high in the volume of PMMA injected, which needed postoperative oxygen support.

Hence, it was inferred that cement leakage is relatively common but mostly of no clinical significance. Percutaneous vertebroplasty in thoracic spine and high amount of PMMA injected should be treated with caution in clinical practice.

Source: Hsieh M, Kao F, Chiu P et al. Risk factors of neurological deficit and pulmonary cement embolism after percutaneous vertebroplasty. J OrthopSurg Res. 2019;14(1). doi:10.1186/s13018-019-1459-4