Science Journal of Clinical Medicine

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Kyphoplasty Cement Embolization and Successful Cement Retrieval from Tricuspid Valve Entrapment

Received: 3 January 2024    Accepted: 16 January 2024    Published: 1 February 2024
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Abstract

This case report details successful percutaneous management of cement embolization, a known complication of kyphoplasty, in a 60-year-old female with osteoporotic compression fractures undergoing T7 and T8 vertebral augmentation. Kyphoplasty, a procedure involving the injection of polymethyl methacrylate (PMMA) cement into the vertebral body, can result in cement leakage with the potential for serious negative outcomes, including pulmonary embolism. In this patient, post-procedure imaging revealed cement extravasation extending into paravertebral veins with embolization terminating in the right ventricle. Traditional treatment options for cement emboli include anticoagulant therapy or operative embolectomy, both of which are either limited in their efficacy, or have significant added risk that must be weighed. However, this report demonstrates the successful use of a percutaneous cement retrieval approach as a viable option for cement retrieval. With retrieval success and the development of an asymptomatic pulmonary embolism, this approach to treatment proved effective in managing the patient's condition without the need for more invasive surgical interventions. This case adds to the current body of literature on cement extravasation in vertebral augmentation procedures, highlighting the importance of careful procedural planning, real-time monitoring, and prompt response to complications. Also, we highlight the use of newer interventional tools that can make cement retrieval more effective.

DOI 10.11648/sjcm.20241301.12
Published in Science Journal of Clinical Medicine (Volume 13, Issue 1, April 2024)
Page(s) 9-15
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Kyphoplasty, Embolization, Retrieval

References
[1] Patel A, Petrone B, Carter KR. Percutaneous Vertebroplasty and Kyphoplasty. [Updated 2023 May 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK525963/
[2] Matouk CC, Krings T, Ter Brugge KG, Smith R. Cement embolization of a segmental artery after percutaneous vertebroplasty: a potentially catastrophic vascular complication. Interv Neuroradiol. 2012 Sep; 18(3): 358-62. doi: 10.1177/159101991201800318. Epub 2012 Sep 10. PMID: 22958778; PMCID: PMC3442313.
[3] Eck JC, Nachtigall D, Humphreys SC, Hodges SD. Comparison of vertebroplasty and balloon kyphoplasty for treatment of vertebral compression fractures: a meta-analysis of the literature. Spine J. 2008 May-Jun; 8(3): 488-97. doi: 10.1016/j.spinee.2007.04.004. Epub 2007 May 29. PMID: 17588820.
[4] Lamparello NA, Jaswani V, DeSousa K, Shapiro M, Kovacs S. Percutaneous Retrieval of an Embolized Kyphoplasty Cement Fragment From the Pulmonary Artery: A Case Report and Literature Review. J Radiol Case Rep. 2016 Jul 31; 10(7): 40-47. doi: 10.3941/jrcr.v10i7.2806. PMID: 27761188; PMCID: PMC5065278.
[5] Zhao Y, Liu T, Zheng Y, Wang L, Hao D. Successful percutaneous retrieval of a large pulmonary cement embolus caused by cement leakage during percutaneous vertebroplasty: case report and literature review. Spine. 2014; 39(26)
[6] Bose R, Choi JW. Successful percutaneous retrieval of methyl methacrylate orthopedic cement embolism from the pulmonary artery. Catheter Cardiovasc Interv. 2010; 76: 198–201.
[7] Lim KJ, Yoon SZ, Jeon YS, Bahk JH, Kim CS, Lee JH, Ha JW. An intraatrial thrombus and pulmonary thromboembolism as a late complication of percutaneous vertebroplasty. Anesth Analg. 2007 Apr; 104(4): 924-6. doi: 10.1213/01.ane.0000256974.84535.7a. PMID: 17377108.
[8] Donnally III, Chester J., Christine M. DiPompeo, and Matthew Varacallo. "Vertebral compression fractures." StatPearls [Internet]. StatPearls Publishing, 2023. https://www.ncbi.nlm.nih.gov/books/NBK448171/
[9] Heini, Paul F., and Rene Orler. "Kyphoplasty for treatment of osteoporotic vertebral fractures." European spine journal 13 (2004): 184-192. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3468137/
[10] Kasperk, Christian, et al. "Three-year outcomes after kyphoplasty in patients with osteoporosis with painful vertebral fractures." Journal of Vascular and Interventional Radiology 21.5 (2010): 701-709. https://pubmed.ncbi.nlm.nih.gov/20304677/#:~:text=Conclusions%3A%20Kyphoplasty%20reduces%20pain%20and,fractures%20is%20reduced%20versus%20controls.
[11] Yeh, Kuei-Lin, et al. "Outcomes of different minimally invasive surgical treatments for vertebral compression fractures: An observational study." World Journal of Clinical Cases 9.31 (2021): 9509. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8610862/
[12] Hinde, Kenji, et al. "Mortality outcomes of vertebral augmentation (vertebroplasty and/or balloon kyphoplasty) for osteoporotic vertebral compression fractures: a systematic review and meta-analysis." Radiology 295.1 (2020): 96-103. https://pubs.rsna.org/doi/full/10.1148/radiol.2020191294
[13] Patel, Zalak, Rahul Sangani, and Cara Lombard. "Cement pulmonary embolism after percutaneous kyphoplasty: An unusual culprit for non–thrombotic pulmonary embolism." Radiology Case Reports 16.11 (2021): 3520-3525. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8436128/#:~:text=Bone%20cement%20(PMMA)%20pulmonary%20embolism,%25%2C%20respectively%20%5B5%5D.
[14] Kang, Hye-Rin, et al. "The impact of incidental pulmonary cement embolism on mortality risk." Journal of Thrombosis and Thrombolysis 49 (2020): 468-474. https://pubmed.ncbi.nlm.nih.gov/32052316/
[15] Semaan, Hassan, et al. "Clinical outcome and subsequent sequelae of cement extravasation after percutaneous kyphoplasty and vertebroplasty: a comparative review." Acta radiologica 59.7 (2018): 861-868. https://journals.sagepub.com/doi/10.1177/0284185117732599?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed#bibr32-0284185117732599
[16] Borg, N., et al. "Anatomy of spinal venous drainage for the neurointerventionalist: from puncture site to intervertebral foramen." American Journal of Neuroradiology 43.4 (2022): 517-525. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8993202/#:~:text=The%20accessory%20hemiazygos%20vein%20usually,drain%20into%20the%20azygos%20vein.
[17] Green, Keva, Vamsi Reddy, and Jeffery P. Hogg. "Neuroanatomy, Spinal Cord Veins." (2019). https://www.ncbi.nlm.nih.gov/books/NBK542182/
[18] Köcher, Stephanie Eva, and Erich Hofmann. "Epidural venous thrombosis as differential diagnosis in back pain patients." Neuroradiology 60.2 (2018): 133-136. https://link.springer.com/article/10.1007/s00234-017-1958-0
[19] Hirsch JA, Chandra RV, Carter NS, Beall D, Frohbergh M, Ong K. Number Needed to Treat with Vertebral Augmentation to Save a Life. AJNR Am J Neuroradiol. 2020 Jan; 41(1): 178-182. doi: 10.3174/ajnr.A6367. Epub 2019 Dec 19. PMID: 31857326; PMCID: PMC6975314.
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  • APA Style

    Boscarello, T., Boparai, R., Whooley, M., Anderson, Z., Bosse, B., et al. (2024). Kyphoplasty Cement Embolization and Successful Cement Retrieval from Tricuspid Valve Entrapment. Science Journal of Clinical Medicine, 13(1), 9-15. https://doi.org/10.11648/sjcm.20241301.12

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    ACS Style

    Boscarello, T.; Boparai, R.; Whooley, M.; Anderson, Z.; Bosse, B., et al. Kyphoplasty Cement Embolization and Successful Cement Retrieval from Tricuspid Valve Entrapment. Sci. J. Clin. Med. 2024, 13(1), 9-15. doi: 10.11648/sjcm.20241301.12

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    AMA Style

    Boscarello T, Boparai R, Whooley M, Anderson Z, Bosse B, et al. Kyphoplasty Cement Embolization and Successful Cement Retrieval from Tricuspid Valve Entrapment. Sci J Clin Med. 2024;13(1):9-15. doi: 10.11648/sjcm.20241301.12

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  • @article{10.11648/sjcm.20241301.12,
      author = {Todd Boscarello and Robby Boparai and Maximillian Whooley and Zoe Anderson and Ben Bosse and Karthik Raghuram and Alexander Vogel},
      title = {Kyphoplasty Cement Embolization and Successful Cement Retrieval from Tricuspid Valve Entrapment},
      journal = {Science Journal of Clinical Medicine},
      volume = {13},
      number = {1},
      pages = {9-15},
      doi = {10.11648/sjcm.20241301.12},
      url = {https://doi.org/10.11648/sjcm.20241301.12},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.sjcm.20241301.12},
      abstract = {This case report details successful percutaneous management of cement embolization, a known complication of kyphoplasty, in a 60-year-old female with osteoporotic compression fractures undergoing T7 and T8 vertebral augmentation. Kyphoplasty, a procedure involving the injection of polymethyl methacrylate (PMMA) cement into the vertebral body, can result in cement leakage with the potential for serious negative outcomes, including pulmonary embolism. In this patient, post-procedure imaging revealed cement extravasation extending into paravertebral veins with embolization terminating in the right ventricle. Traditional treatment options for cement emboli include anticoagulant therapy or operative embolectomy, both of which are either limited in their efficacy, or have significant added risk that must be weighed. However, this report demonstrates the successful use of a percutaneous cement retrieval approach as a viable option for cement retrieval. With retrieval success and the development of an asymptomatic pulmonary embolism, this approach to treatment proved effective in managing the patient's condition without the need for more invasive surgical interventions. This case adds to the current body of literature on cement extravasation in vertebral augmentation procedures, highlighting the importance of careful procedural planning, real-time monitoring, and prompt response to complications. Also, we highlight the use of newer interventional tools that can make cement retrieval more effective.
    },
     year = {2024}
    }
    

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    AU  - Robby Boparai
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    AB  - This case report details successful percutaneous management of cement embolization, a known complication of kyphoplasty, in a 60-year-old female with osteoporotic compression fractures undergoing T7 and T8 vertebral augmentation. Kyphoplasty, a procedure involving the injection of polymethyl methacrylate (PMMA) cement into the vertebral body, can result in cement leakage with the potential for serious negative outcomes, including pulmonary embolism. In this patient, post-procedure imaging revealed cement extravasation extending into paravertebral veins with embolization terminating in the right ventricle. Traditional treatment options for cement emboli include anticoagulant therapy or operative embolectomy, both of which are either limited in their efficacy, or have significant added risk that must be weighed. However, this report demonstrates the successful use of a percutaneous cement retrieval approach as a viable option for cement retrieval. With retrieval success and the development of an asymptomatic pulmonary embolism, this approach to treatment proved effective in managing the patient's condition without the need for more invasive surgical interventions. This case adds to the current body of literature on cement extravasation in vertebral augmentation procedures, highlighting the importance of careful procedural planning, real-time monitoring, and prompt response to complications. Also, we highlight the use of newer interventional tools that can make cement retrieval more effective.
    
    VL  - 13
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Author Information
  • Reno School of Medicine, University of Nevada, Reno, USA

  • Reno School of Medicine, University of Nevada, Reno, USA

  • School of Medicine-Phoenix, Creighton University, Arizona, USA

  • Reno School of Medicine, University of Nevada, Reno, USA

  • Reno School of Medicine, University of Nevada, Reno, USA

  • Reno Radiological Associates, Reno, USA

  • Reno Radiological Associates, Reno, USA

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