SHM Converge Scientific Abstract ePoster Gallery-Symptomatic Presentation of Cement Embolization After Vertebroplasty

Pdf Summary

This case report describes a 51-year-old woman who developed symptomatic pulmonary cement embolism after vertebroplasty performed during thoracic spine surgery for metastatic breast cancer. She initially presented after a ground-level fall with severe thoracic back pain, bilateral leg weakness and numbness, and urinary incontinence. Imaging showed a pathologic T7 compression fracture, epidural tumor extension, and severe spinal cord compression. She underwent open reduction and internal fixation with T5-T10 posterior fusion, T7 corpectomy, and vertebroplasty.<br /><br />Pulmonary cement embolism is a known complication of vertebroplasty, with reported incidence ranging from 3.5% to 23%, though symptomatic cases are much less common. Cement is thought to leak into the paravertebral venous plexus and travel to the pulmonary arterial system. Symptoms may occur intraoperatively or postoperatively; postoperative dyspnea is most common, but chest pain, tachycardia, hypoxia, and lightheadedness can also occur.<br /><br />The report highlights imaging findings of cement emboli, including involvement of the azygos vein, right atrium, and bilateral pulmonary arterial branches. Because there are no established management guidelines, treatment depends on embolus location and clinical status. The authors recommend close postoperative monitoring of oxygenation and hemodynamics, with CT as the first-line diagnostic test if embolism is suspected. Anticoagulation should be individualized based on bleeding risk and clinical presentation. Suggested regimens include heparin followed by warfarin for 3–6 months, or rivaroxaban/apixaban for at least 3 months as alternatives.<br /><br />Overall, the case emphasizes the need for high clinical suspicion for cement embolism after vertebroplasty and supports prompt imaging and tailored anticoagulation management.

Asset Subtitle

Thomas H. Etheridge

Meta Tag

Author List Daniel S. AHN, Elena Jiménez Gutiérrez, Jessica Wong, Olen J. Haseman, Thomas H. Etheridge

Category Clinical Vignettes

Concept Vertebroplasty

Concept Pulmonary cement embolism

Concept Vertebral compression fracture

Concept CT Imaging

Concept Cement Embolization

Distinguished Non-Finalist

Presenter Organization The University of Texas Health Science Center at San Antonio Long School of Medicine

Presenting Author Thomas H. Etheridge

Track Adult

Keywords

pulmonary cement embolism

vertebroplasty

metastatic breast cancer

thoracic spine surgery

spinal cord compression

cement emboli

CT imaging

anticoagulation

azygos vein

right atrium

Vertebroplasty

Pulmonary cement embolism

Vertebral compression fracture

CT Imaging

Cement Embolization