PMID- 28821988 OWN - NLM STAT- MEDLINE DCOM- 20191113 LR - 20191113 IS - 1432-0932 (Electronic) IS - 0940-6719 (Linking) VI - 27 IP - 10 DP - 2018 Oct TI - Presentation and management of symptomatic central bone cement embolization. PG - 2584-2592 LID - 10.1007/s00586-017-5267-4 [doi] AB - BACKGROUND CONTEXT: With more cement augmentation procedures done, the occurrence of serious complications is also expected to rise. Symptomatic central cement embolization is a rare but very serious complication. Moreover, the pathophysiology and treatment of intrathoracic cement embolism remain controversial. PURPOSE: In this case series, we are trying to identify various presentations and suggest our emergent management scheme for symptomatic central cement embolization. PATIENT SAMPLE: Retrospective case series of nine patients with symptomatic central cement embolism identified after vertebroplasty with 24 months of follow-up. Level IV. OUTCOME MEASURES: The degree of dyspnea measured by the New York Heart Association (NYHA) score and/or death related to cement embolism induced cardio/respiratory failure at the final follow-up at 24 months. METHODS: The nine patients, eight females, and one male had a mean age of 70.25 years (range 65-78 years) and were operated between January 2004 and December 2014. They had percutaneous vertebroplasty for osteoporotic non-traumatic and malignant vertebral collapse of dorsal and lumbar vertebrae. Post-vertebroplasty dyspnea and stitching chest pain were striking in the nine patients. After exclusion of cardiac ischemia and medical pulmonary causes for dyspnea, we identified radiopaque lesions on the chest X-ray. Further echocardiography and high-resolution chest CT were performed for optimal localization. Emergent heart surgery was performed in two patients: interventional therapy was conducted in one patient, while the remaining six patients were conservatively treated by anticoagulation. The management decision was taken in the setting of an interdisciplinary meeting depending on localization, fragmentation, and clinical status. RESULTS: All patients of this series showed gradual improvement and an uneventful hospital stay. During our 24-month follow-up phase, eight patients showed no subsequent cardiological and/or respiratory symptoms (NYHA I). However, one mortality due to advanced malignancy occurred. Preoperative anemia was the only common intersecting preoperative parameter among these nine patients. CONCLUSIONS: After cement augmentation, close clinical monitoring is mandatory. A chest CT is pivotal in determining the interdisciplinary management approach in view of the availability of necessary expertise, facilities and the location of the cement emboli whether accessible by cardiac or vascular surgical means. The clinical presentation and its timing may vary and the patient may be seen subsequently by other health care providers obligating a wide-spread awareness for this serious entity among health care providers for this age group as spine surgeons, family and emergency room doctors, and institutional or home-care nurses. Most symptomatic central cement emboli may be treated conservatively. FAU - Barakat, Ahmed Samir AU - Barakat AS AUID- ORCID: 0000-0002-6778-2364 AD - Department of Spinal Surgery, Zentralklinik Bad Berka, Wirbelsaulenchirurgie, Robert-Koch Allee 9, 99438, Bad Berka, Germany. ahmedsamir222222@live.com. AD - Department of Orthopedics and Traumatology, Cairo University, Cairo, Egypt. ahmedsamir222222@live.com. FAU - Owais, Tamer AU - Owais T AD - Department of Cardiac Surgery, Zentralklinik Bad Berka, Bad Berka, Germany. AD - Department of Cardiothoracic Surgery, Cairo University, Cairo, Egypt. FAU - Alhashash, Mohamed AU - Alhashash M AD - Department of Spinal Surgery, Zentralklinik Bad Berka, Wirbelsaulenchirurgie, Robert-Koch Allee 9, 99438, Bad Berka, Germany. AD - Department of Orthopedics and Spinal Surgery, Alexandria University Hospitals, Alexandria, Egypt. FAU - Shousha, Mootaz AU - Shousha M AD - Department of Spinal Surgery, Zentralklinik Bad Berka, Wirbelsaulenchirurgie, Robert-Koch Allee 9, 99438, Bad Berka, Germany. AD - Department of Orthopedics and Spinal Surgery, Alexandria University Hospitals, Alexandria, Egypt. FAU - El Saghir, Hesham AU - El Saghir H AD - Department of Orthopedics and Spinal Surgery, Alexandria University Hospitals, Alexandria, Egypt. FAU - Lauer, Bernward AU - Lauer B AD - Department of Cardiology, Zentralklinik Bad Berka, Bad Berka, Germany. FAU - Boehm, Heinrich AU - Boehm H AD - Department of Spinal Surgery, Zentralklinik Bad Berka, Wirbelsaulenchirurgie, Robert-Koch Allee 9, 99438, Bad Berka, Germany. LA - eng PT - Journal Article DEP - 20170818 PL - Germany TA - Eur Spine J JT - European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society JID - 9301980 RN - 0 (Bone Cements) SB - IM MH - Aged MH - Bone Cements/*adverse effects MH - *Embolism/chemically induced/diagnostic imaging MH - Female MH - Humans MH - Male MH - Radiography, Thoracic MH - Retrospective Studies MH - Tomography, X-Ray Computed MH - Vertebroplasty/adverse effects OTO - NOTNLM OT - Conservative treatment OT - Open heart and minimally invasive heart surgery OT - Pulmonary cement emboli and central symptomatic bone embolization OT - Radiological interventionist OT - Vertebral cement leakage EDAT- 2017/08/20 06:00 MHDA- 2019/11/14 06:00 CRDT- 2017/08/20 06:00 PHST- 2017/04/08 00:00 [received] PHST- 2017/08/11 00:00 [accepted] PHST- 2017/08/20 06:00 [pubmed] PHST- 2019/11/14 06:00 [medline] PHST- 2017/08/20 06:00 [entrez] AID - 10.1007/s00586-017-5267-4 [pii] AID - 10.1007/s00586-017-5267-4 [doi] PST - ppublish SO - Eur Spine J. 2018 Oct;27(10):2584-2592. doi: 10.1007/s00586-017-5267-4. Epub 2017 Aug 18.