Artikel
Cement embolism into the venous system after pedicle screw fixation in osteopenic patients
Suche in Medline nach
Autoren
Veröffentlicht: | 26. April 2013 |
---|
Gliederung
Text
Introduction: Due to growing elderly population, the number of patients with low bone quality is increasing. Subsequently, more age related bone diseases such as instability in cases of vertebral fractures due to osteoporosis will increase the frequency of pedicle screw instrumentation procedures. The strength of pedicle screws attachment to the vertebrae is an important factor affecting their motion resistance and long term performance. But the low bone quality in osteopenic patients keeps the screw bone interface at risk for subsidence and dislocation. In such cases, bone cement could be used to augment pedicle screw fixation. However, its use is not free of risk. Therefore, clinicians, especially spine surgeons, should become increasingly aware of cement migration and embolism as possible complications.
Material and methods: We present an instructive case of an 87-year-old man diagnosed with spondylolisthesis due to a non-traumatic osteoporotic compression fracture of the 3rd lumbar vertebra. After augmented screw fixation a cement embolism into the venous system was noticed. Here, we discuss pathophysiology and prevention methods as well as therapeutic management of this potentially life-threatening complication.
Conclusion: Creating a void within the vertebral body and cements injections in suitable consistency under low pressure reduce the risk of cement embolism after augmented screw fixation. Furthermore, an early postoperative CT is recommended not only to check the proper implants position but also to detect possible cement migration, which leads to appropriate processing before clinical deterioration.
In cases of cement embolism into the venous system an anitcoagulation therapy has no negative effects on the clinical course if the contraindications are respected. Moreover, it appears to be positively effective on the prevention of pulmonary embolism. Nevertheless, the decision not to start an anticoagulation therapy in asymptomatic cases cannot be interpreted as a lack of treatment as long as no data support the formation of thrombi on the cement. Figure 1 [Fig. 1].