Clinical case of pulmonary cement embolism and adjacent fractures as a complication after vertebroplasty

Abstract

Introduction: Osteoporosis is a skeleton disease with reduction in bone mass and disruption of the bone microstructure. A rare secondary form is pregnancy-associated osteoporosis. The standard method for determining bone density is DEXA measurement (dual X-ray absorptiometry). With the radiofrequency echographic multi spectrometry (REMS) method this is done using ultrasound without radiation exposure. Osteoporosis often leads to pathological fractures of the vertebrae. In case of severe pain and immobilization vertebroplasty is considered standard procedure. However, it can have side effects such as cement leakage into surrounding tissue, pulmonary embolism and adjacent fractures. Case: We present a 27-year-old female patient with compression fractures of the Th8 and Th12 5 months after labour. DEXA measurements showed values of the T-score at hip neck -2,5 SD (total) and -3,5 SD (L1-L4) at spine. The fractures of the Th8 and Th12 were then treated with vertebroplasty. A post-operative CT showed cement leakage and extravasation, as well as bilateral cement embolism of the proximal branches of the pulmonary arteries and progression of the height loss of Th5, Th7 and L1. Discussion: Pulmonary cement embolism is a rare complication of vertebroplasty. Cement leakage is more frequent complication, although most of the time asymptomatic. These risks of complications make the alternative conservative treatment worth considering before proceeding to surgical interventions. Only after failure to achieve adequate pain management kyphoplasty or vertebroplasty should be considered, due to the risks of prolonged immobilization of the patient leading to further bone and muscle loss. Conclusion: Pregnancy associated osteoporosis is very rare.  The radiation free REMS method is suitable for pregnant women. Vertebroplasty offers pain relief and rapid mobilization of the patient. However, it poses a risk of numerous complications. The osteoporotic fractures of the vertebrae are usually stable and a conservative treatment prior to surgical interventions should always be considered.