Clinical Study
Incidence of Pulmonary Cement Embolism after Real-Time CT Fluoroscopy–guided Vertebroplasty

https://doi.org/10.1016/j.jvir.2013.05.048Get rights and content

Abstract

Purpose

To prospectively evaluate the incidence of pulmonary cement embolism (PCE) after vertebroplasty in procedures performed under real-time computed tomographic (CT) fluoroscopy guidance.

Materials and Methods

A total of 85 vertebroplasties were performed in 51 consecutive patients (31 women, 20 men; mean age, 71.9 y; range, 48–92 y) in 51 sessions. The needle was inserted with guidance from intermittent single-shot CT scans, and intermittent CT fluoroscopy was used during cement injection only. To reduce the risk of extravertebral or extraosseous leakage, several procedures (cement injection stopping/slowing, needle position changes) were employed. The chest and treated bone were scanned immediately after vertebroplasty. These CT images included the entire thorax as well as the treated vertebrae.

Results

No cement emboli were observed on CT after vertebroplasty. After 85 vertebroplasty procedures, 44 extravertebral leaks were detected. Epidural leaks were observed on CT in six treated vertebrae (7%), in 12 cases in the anterior external venous plexus (14.1%), in five in the azygos vein (5.8%), in 19 in the disc space (22%), and in two in the foraminal space (2.3%). On a per-patient basis, the odds of leaks increased with the number of vertebroplasties (P = .05) and the volume of cement used (P = .0412). There was also a higher probability of leak (P < .05) for osteoporotic vertebral compression fractures (67.9%; 95% confidence interval, 47.7%–84.1%) than osteolytic spinal metastases (34.8%; 16.4%–57.3%).

Conclusions

PCE did not occur after vertebroplasty under CT fluoroscopy guidance. Further larger prospective vertebroplasty studies are needed to compare the rates of PCE for CT versus conventional fluoroscopic guidance.

Section snippets

Materials and Methods

The study was approved by our institutional review board, and written informed consent separately concerning the procedure and the study were obtained from all patients (N = 51). A baseline chest CT scan was performed the week before the procedure. Immediately after each vertebroplasty session, the entire thorax and treated bone were scanned with a multidetector CT scanner with a section thickness of 1 mm. Contrast enhancement was not used (4).

Between March 2009 and December 2012, all

Results

The results are summarized in Table 2, Table 3 and in Figure 3. During the study period, 51 patients (31 women, 20 men; mean age, 71.9 y; range, 48–92 y) underwent 85 vertebroplasty procedures in 51 sessions and form our study population. Of these 51 patients, 28 presented with OVCFs and 23 with osteolytic spinal metastases. The primary malignancies for the patients with cancer included multiple myeloma (n = 1), non–small-cell lung cancer (n = 18), small-cell lung cancer (n = 2), esophageal

Discussion

In this prospective study, no PCE was detected after vertebroplasty under CT fluoroscopy guidance. Similar to other authors (4, 5, 6), we performed chest CT after each session of vertebroplasty and failed to detect PCE even though the mean injected cement volume and the incidence of extraosseous leakage were similar those in to most published studies (4, 5, 6).

The clinical importance of PCE is uncertain because most cases are asymptomatic (13). However, some clinical case reports and studies

References (21)

There are more references available in the full text version of this article.

Cited by (0)

None of the authors have identified a conflict of interest.

View full text
Copyright © 2013 SIR. Published by Elsevier Inc. All rights reserved.