• Youssef Abdul-Jalil, Joerg Bartels, Olaf Alberti, and Ralf Becker.
• Department of Neurosurgery, Asklepios Klinik Schildautal Seesen, Germany. abdul-jalil@gmx.de
• Spine. 2007 Sep 15; 32 (20): E589-93.

Study DesignLiterature review concerning pulmonary embolism of polymethylmethacrylate (PMMA) material following percutaneous vertebroplasty and a report on 2 new cases.ObjectiveTo inform clinicians about delayed clinical manifestation of pulmonary embolism of polymethylmethacrylate material after percutaneous vertebroplasty, pathophysiology, precautions, and therapeutic management of this complication.Summary Of Background DataPercutaneous vertebroplasty is a minimal invasive intervention used to treat vertebral fractures, which yields good therapeutic results and rarely produces complications. Nevertheless, serious complications may occur. Pulmonary PMMA embolism, which has been recently reported in some cases, is one of these.Methods And ResultsWe report on 2 cases of pulmonary embolism of PMMA material after percutaneous vertebroplasty. In the case of a 45-year-old female patient, symptoms of pulmonary embolism arose with a delay of 3 days following percutaneous vertebroplasty. A therapy with low-molecular-weight heparin, Enoxaparin, enabled recovery from pulmonary failure. The second case occurred without detection of any cement leakage into the paravertebral venous system, neither intraoperatively nor perioperatively. The existence of PMMA in pulmonary vessels was detected 1 year later and remained asymptomatic.ConclusionThese 2 cases allow us to conclude that the risk of pulmonary embolism of PMMA might be underestimated. We propose routine chest radiograph following every vertebroplasty, in order to detect pulmonary PMMA embolism and thereby prevent serious delayed cardiopulmonary failures.

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