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• Asymptomatic diffuse pulmonary embolism caused by acrylic cement : an unusual complication of percut
  Grados Franck
  Published on: 6 March 2003

• Published on: 6 March 2003

  Asymptomatic diffuse pulmonary embolism caused by acrylic cement : an unusual complication of percut

  • Grados Franck, MD
  • Other Contributors:
    • Hervé Deramondm, Patrice Fardellone

  Dear Editor

  We read with interest the letter by Bernhard et al.[1] Pulmonary embolism caused by polymethylmethacrylate (PMMA) is not an exceptional complication of percutaneous vertebroplasty for the treatment of osteoporotic vertebral fractures. It occured in one patient (2.9%) in our study [2] (34 vertebroplasties), in two patients (4.3%) in the study by Jensen [3] et al. (47 vertebroplasties) and i...

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  Dear Editor

  We read with interest the letter by Bernhard et al.[1] Pulmonary embolism caused by polymethylmethacrylate (PMMA) is not an exceptional complication of percutaneous vertebroplasty for the treatment of osteoporotic vertebral fractures. It occured in one patient (2.9%) in our study [2] (34 vertebroplasties), in two patients (4.3%) in the study by Jensen [3] et al. (47 vertebroplasties) and in one patient (4.8%) in the study by Legroux-Gérot [4,5] et al. (21 vertebroplasties). Fortunately, there were no symptoms : small emboli were discovered fortuisly on routine chest films. To our knowledge, eleven cases of pulmonary embolism caused by PMMA after percutaneous vertebroplasty have been reported, six [1-6] in the treatment of osteoporotic vertebral fractures, three [7] in the treatment of spinal metastasis, one in the treatment of histiocytosis [8] and osteogenesis imperfecta.[9] Five cases were symptomatic, one case was lethal.[6] Like Bernhard et al,[1] our experience suggests that a venography before vertebroplasty is not required in the treatment of osteoporotic vertebral fractures. We believe that this complication can be prevented by ensuring that the viscosity of the cement is not too thin and by injecting the cement into the vertebral body under continuous meticulous lateral fluoroscopic control. We recommend in futures studies systematic chest radiograph after vertebroplasty or kyphoplasty to precisely evaluate the risk of this potentially serious complication.

  References

  (1) Bernhard J, Heini PF, Villiger PM. Asymptomatic diffuse pulmonary embolism caused by acrylic cement : an unusual complication of percutaneous vertebroplasty. Ann Rheum Dis2003;62:85-6.

  (2) Grados F, Depriester C, Cayrolle G et al. Long-term observations of vertebral osteoporotic fractures treated by percutaneous vertebroplasty. Rheumatology 2000;39:1410-4.

  (3) Jensen ME, Evans AJ, Mathis JM et al. Percutaneous polymethylmethacrylate vertebroplasty in the treatment of osteoporotic vertebral body compression fractures : technical aspects. AJNR Am J Neuroradiol 1997;18:1897-904.

  (4) Legroux-Gérot I, Lormeau C, Boutry N et al. Suivi à long terme de fractures vertébrales ostéoporotiques traitées par vertébroplastie percutanée. Rev Rhum 2002;69:1039.

  (5) Lormeau C. Suivi à long-terme de fractures vertébrales ostéoporotiques traitées par vertébroplastie percutanée. [Mémoire de rhumatologie] Lille, France, 2001.

  (6) Chen HL, Wong CS, Ho ST et al. A lethal pulmonary embolism during percutaneous vertebroplasty. Anesth Analg 2002;95:1060-2.

  (7) Jang JS, Lee SH, Jung SK. Pulmonary embolism of polymethylmethacrylate after percutaneous vertebroplasty : a report of three cases. Spine 2002;27:E416-8.

  (8) Padovani B, Kasriel O, Brunner Ph, Peretti-Viton P. Pulmonary embolism caused by acrylic cement : a rare complication of percutaneous vertebroplasty. >AJNR Am J Neuroradiol 1999;20:375-7.

  (9) Tozzi P, Abdelmoumene Y, Corno AF et al. Management of pulmonary embolism during acrylic vertebroplasty. Ann Thorac Surg 2002;74:1706-8.

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  Conflict of Interest:
  None declared.

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