gms | German Medical Science

130. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

30.04. - 03.05.2013, München

Cement embolism into the venous system after pedicle screw fixation in osteopenic patients

Meeting Abstract

  • Venant Ekengele - Klinikum Nürnberg, Neurochirurgische Klinik, Nürnberg
  • Ghassan Kerry - Klinikum Nürnberg, Neurochirurgische Klinik, Nürnberg
  • Claus Ruedinger - Klinikum Nürnberg, Neurochirurgische Klinik, Nürnberg
  • Hans-Herbert Steiner - Klinikum Nürnberg, Neurochirurgische Klinik, Nürnberg

Deutsche Gesellschaft für Chirurgie. 130. Kongress der Deutschen Gesellschaft für Chirurgie. München, 30.04.-03.05.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. Doc13dgch359

doi: 10.3205/13dgch359, urn:nbn:de:0183-13dgch3596

Veröffentlicht: 26. April 2013

© 2013 Ekengele et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


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].