Expert’s comment concerning Grand Rounds case entitled “Intracardiac bone cement embolism as a complication of vertebroplasty: management strategy” by Hatzantonis C, Czyz M, Pyzik R, Boszczyk BM. (Eur Spine J; 2016. doi:10.1007/s00586-016-4695-x)

Excerpt

Percutaneous vertebroplasty was introduced in 1984 for the treatment of spinal hemangiomas [1] and since then has evolved into a relatively safe and simple procedure to stabilise diseased or fractured vertebral bodies. Nevertheless, complications may arise when injection of polymethylmethacrylate (PMMA) cement into a vertebral body causes local extravasation or leakage of cement into paravertebral veins, which can then embolise to the heart and lungs. Estimates of the incidence of venous cement embolism in patients undergoing vertebroplasty vary widely, reflecting the small sample sizes of the available studies and differences in the methods of detection. Routine chest radiography after vertebroplasty detects pulmonary cement embolism in 2.1–6.8% of cases [2‐5] but studies of the systematic use of computed tomography after vertebroplasty report pulmonary cement embolism in 9.4–26% of patients [6, 7]. Most of the patients in these studies were asymptomatic and the incidence of cement embolism after vertebroplasty in routine practice may, therefore, be substantially higher than currently appreciated. …