Liang TZ, Zhu HP, Gao B, Peng Y, Gao WJ. Intracardiac, pulmonary cement embolism in a 67-year-old female after cement-augmented pedicle screw instrumentation: A case report and review of literature. World J Clin Cases 2021; 9(13): 3120-3129 [PMID: 33969099 DOI: 10.12998/wjcc.v9.i13.3120]
Corresponding Author of This Article
Wen-Jie Gao, MD, PhD, Attending Doctor, Department of Orthopedics, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 33 Yingfeng Road, Haizhu District, Guangzhou 510289, Guangdong Province, China. gaowj7@mail.sysu.edu.cn
Research Domain of This Article
Medicine, Research & Experimental
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. May 6, 2021; 9(13): 3120-3129 Published online May 6, 2021. doi: 10.12998/wjcc.v9.i13.3120
Intracardiac, pulmonary cement embolism in a 67-year-old female after cement-augmented pedicle screw instrumentation: A case report and review of literature
Tong-Zhou Liang, Hai-Peng Zhu, Bo Gao, Yan Peng, Wen-Jie Gao
Tong-Zhou Liang, Bo Gao, Yan Peng, Wen-Jie Gao, Department of Orthopedics, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510289, Guangdong Province, China
Hai-Peng Zhu, Department of Orthopedics, Guangdong Women and Children Hospital, Guangzhou 511400, Guangdong Province, China
Author contributions: Liang TZ and Zhu HP contributed equally to the work; Liang TZ, Zhu HP, and Gao B provided patient care, monitored the patient’s vital signs, provided treatment, and abstracted laboratory and clinical data; Gao WJ and Zhu HP performed a regular follow-up of the patient; Peng Y, Gao WJ, and Liang TZ contributed to the writing of the manuscript; All authors reviewed and approved the final manuscript and issued final approval for the version to be submitted.
Supported byFundamental Research Funds for the Central Universities, No. 20ykpy94.
Informed consent statement: The patient and her families provided informed written consent form for reporting the case.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wen-Jie Gao, MD, PhD, Attending Doctor, Department of Orthopedics, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 33 Yingfeng Road, Haizhu District, Guangzhou 510289, Guangdong Province, China. gaowj7@mail.sysu.edu.cn
Received: November 24, 2020 Peer-review started: November 24, 2020 First decision: January 24, 2021 Revised: February 4, 2021 Accepted: March 3, 2021 Article in press: March 3, 2021 Published online: May 6, 2021 Processing time: 143 Days and 9.1 Hours
Abstract
BACKGROUND
We report a case of Intracardiac, pulmonary, and intravenous cement embolism after cement-augmented pedicle screw instrumentation in treating spondylolisthesis underlying osteoporotic bone, which was successfully managed by conservative treatment. We describe the treatment and outcome of the patient, hoping to shed light on the management of bone cement embolism.
CASE SUMMARY
A 67-year-old female suffered from progressive low back pain and numbness in lower extremities for 30 years. She was diagnosed with L4 and L5 spondylolisthesis, spinal stenosis, and osteoporosis. The patient underwent spinal canal decompression, an interbody fusion of L4/5 and L5/S1, cement-augmented pedicle screw instrumentation in L4-L5 segments, and regular pedicle screw in S1 segments. Three days postoperatively, a sudden drop in oxygen saturation occurred. Computerized tomography scan confirmed Intracardiac, pulmonary, and intravenous embolism. The patient was treated conservatively by continuous low-flow oxygen inhalation, anti-coagulation, and antibiotic therapy for 1 mo and continued anticoagulation treatment for 6 mo. The patient showed no further symptoms in a 30-mo follow-up.
CONCLUSION
Intracardiac, pulmonary cement embolism after cement-augmented pedicle screw instrumentation is extremely rare. Careful clinical and radiographic evaluation is required in multiple sites of bone cement embolism. Conservative treatment may be a primary consideration in scattered emboli without life-threatening conditions, but a clinical decision should be made on an individualized basis.
Core Tip: Intracardiac and pulmonary cement embolism event after cement-augmented pedicle screw instrumentation is an extremely rare complication in orthopedics surgery. In our case, the patient developed no symptoms except for rapid decrease in oxygen saturation to 70%. The case presents evidence for treating cement embolism cases without severe life-threatening complications, which include close monitoring, oxygen inhalation, anti-coagulation, and antibiotic therapy. This case improves our understanding of bone cement embolism and informs optimization of the duration and type of anticoagulant drugs to be used when the complication occurs.
