Pulmonary Bone Cement Embolism following Pedicle Screw Instrumentation with Bone Cement Augmentation for a Burst Fracture of L1 in a Non-Osteoporotic Spine

Jose Manuel F. Ignacio1 and Sharon D. Ignacio2

1Department of Orthopedics, College of Medicine and
Philippine General Hospital, University of the Philippines Manila
2Department of Rehabilitation Medicine, College of Medicine and
Philippine General Hospital, University of the Philippines Manila

This is a case of pulmonary cement embolism in a young non-osteoporotic patient who sustained a burst fracture of L1. Bone cement augmentation was done for the fractured vertebra as well as over other segments where pedicle screws were inserted. The procedure eventually led to pulmonary cement embolism. The pathway for cement to reach the pulmonary vasculature from within the vertebral body is shown thru a series of imaging studies with the CT Scan done for the patient showing the route taken by the cement as it proceeds towards the pulmonary artery. This is rarely, if ever, shown in published literature. The literature is reviewed further to provide a rational management strategry for such a potentially life threatening condition.

Key Words: pulmonary cement embolism, vertebroplasty, kyphoplasty, cement augmentation of pedicle screw, burst fracture, PMMA (polymethyl methacrylate)