Article
High rate of pulmonary cement embolism (PCE) in patients with cement augmented pedicle screw placement with intraoperative perivertebral cement leakage –10-year single-centre experience
Hohe Rate an pulmonalen Zementembolien bei Patienten mit zementaugmentierten Pedikelschrauben und intraoperativem perivertebralem Zementaustritt – Übersicht der letzten 10 Jahre
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Published: | June 26, 2020 |
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Objective: To assess morbidity, mortality and pulmonary cement embolism in patients who had undergone cement augmented pedicle screw placement of the thoracic and lumbar spine.
Methods: 35 patients who had received CT-navigated pedicle screws with cement augmentation for degenerative or traumatic conditions were analyzed retrospectively between June 2009 and July 2019. Only patients with perivertebral cement leakage verified by a CT scan of the thoracic or lumbar spine and additional thoracic CT-scan were analyzed. Complications, mortality and pulmonary cement embolism were determined.
Results: Average age was 72.5 years (range: 47-68 years). A total of 169 vertebral bodies with 337 screws were inserted, of which 238 were cement-augmented. The screws were placed in the lumbar (63%), thoracic (9%) or both lumbar and thoracic (28 %) spine. Perivertebral cement leakage occurred in all patients. PCE occurred in 10 patients (29%). 24 patients (69%) were asymptomatic whereas 11 patients (31%) had symptoms like dyspnea or thoracic pain. In-hospital mortality due to PCE was 9% (3 patients). Mean hospital stay was 15 days.
Conclusion: Our study confirms that cement application for pedicle screw placement leads to PCE in 29% of patients with pulmonary symptoms in 31% of patients. Early mortality related to PCE was 9%.