Symptomatic Pulmonary Cement Embolism after Balloon Kyphoplasty and Pedicle Screw Fixation Caused by a Small Peripheral Embolus- A Case Report


Vol 8 | Issue 3 | September-December 2022 | Page: 05-08 | Masami Sato, Munenori Kato, Masahiro Kakuyama

DOI: 10.13107/jaccr.2022.v08i03.206

Author: Masami Sato [1], Munenori Kato [1], Masahiro Kakuyama [1]

[1] Department of Anaesthesia, Kyoto City Hospital, Kyoto, Japan.

Address of Correspondence
Dr. Masami Sato,
Department of Anaesthesia, Kyoto City Hospital, Kyoto, Japan.


Introduction: Pulmonary cement embolism, which is caused by vertebral cement leakage, is a feared but underestimated complication after balloon kyphoplasty. Most pulmonary cement embolism cases are asymptomatic and symptomatic pulmonary cement embolism have been caused by central or peripheral multiple cement emboli.
Case presentation: A 62-year-old man, who underwent three-level thoracolumbar balloon kyphoplasty and pedicle screw fixation for osteoporotic vertebral compression fracture under general anesthesia, experienced hypoxemia postoperatively and dyspnea 1 day after the surgery. Chest computed tomography revealed a small cement embolus in the peripheral pulmonary artery of the right lower lung and confirmed the diagnosis of pulmonary cement embolism. Transthoracic echocardiogram revealed no right heart strain. He was managed successfully under oxygen administration without anticoagulation therapy.
Conclusion: Pulmonary cement embolism after balloon kyphoplasty should be invariably considered as a differential diagnosis when postprocedural dyspnea or hypoxemia occurs. Even a small peripheral cement embolus can induce symptomatic pulmonary cement embolism after balloon kyphoplasty.
Keywords: Pulmonary cement embolism, Balloon kyphoplasty, Pedicle screw fixation, Anticoagulation, General anesthesia.


1. Barakat AS, Owais T, Alhashash M, Shousha M, Saghir HE, Lauer B, et al. Presentation and management of symptomatic central bone cement embolization. Eur Spine J. 2018;27(10):2584-92.
2. Janssen I, Ryang YM, Gempt J, Bette S, Gerhardt J, Kirschke JS, et al. Risk of cement leakage and pulmonary embolism by bone cement-augmented pedicle screw fixation of the thoracolumbar spine. Spine J. 2017;17(6):837-44.
3. Rahimizadeh A, Hassani V, Soufiani H, Rahimizadeh A, Karimi M, Asgari N. Symptomatic pulmonary cement embolism after pedicle screw polymethylmethacrylate cement augmentation: A case report and review. Surg Neurol Int. 2020;11:18.
4. Rothermich MA, Buchowski JM, Bumpass DB, Patterson GA. Pulmonary cement embolization after vertebroplasty requiring pulmonary wedge resection. Clin Orthop Relat Res. 2014;472(5):1652-7.
5. Stricker K, Orler R, Yen K, Takala J, Luginbühl M. Severe hypercapnia due to pulmonary embolism of polymethylmethacrylate during vertebroplasty. Anesth Analg. 2004;98(4):1184-6.
6. Bliemel C, Buecking B, Struewer J, Piechowiak EI, Ruchholtz S, Krueger A. Detection of pulmonary cement embolism after balloon kyphoplasty: should conventional radiographs become routine? Acta Orthop Belg. 2013;79(4):444-50.
7. Idiculla PS, Rajdev K, Pervaiz S, Cinelli M, Habib S, Siddiqui A, et al. Cement pulmonary embolism after balloon kyphoplasty. Respir Med Case Rep. 2019;28:100887.
8. Patel Z, Sangani R, Lombard C. Cement pulmonary embolism after percutaneous kyphoplasty: an unusual culprit for non-thrombotic pulmonary embolism. Radiol Case Rep. 2021;16(11):3520-5.
9. Waler AR, Sanchez KJ, Parikh AA, Okorie ON. A case of pulmonary cement embolism managed through symptomatic treatment. Case Rep Crit Care. 2020:2425973.
10. Donaldson AJ, Thomson HE, Harper NJ, Kenny NW. Bone cement implantation syndrome. Br J Anaesth. 2009;102(1):12-22.
11. Zou D, Dong S, Du W, Sun B, Wu X. Risk factor analysis of pulmonary cement embolism during percutaneous vertebroplasty or kyphoplasty for osteoporotic vertebral compression fractures. J Orthop Surg Res. 2021;16(1):312.
12. Krueger A, Bliemel C, Zettl R, Ruchholtz S. Management of pulmonary cement embolism after percutaneous vertebroplasty and kyphoplasty: a systematic review of the literature. Eur Spine J. 2009;18(9):1257-65.
13. Mansour A, Abdel-Razeq N, Abuali H, Makoseh M, Shaikh-Salem N, Abushalha K, et al. Cement pulmonary embolism as a complication of percutaneous vertebroplasty in cancer patients. Cancer Imaging. 2018;18(1):5.
14. Kang HR, Kim TH, Chung CK, Lee CH. The impact of incidental pulmonary cement embolism on mortality risk. J Thromb Thrombolysis. 2020;49(3):468-74.

How to Cite this Article: Sato M, Kato M, Kakuyama M |  Symptomatic Pulmonary Cement Embolism after Balloon Kyphoplasty and Pedicle Screw Fixation Caused by a Small Peripheral Embolus- A Case Report | Journal of Anaesthesia and Critical Care Case Reports | September-December 2022; 8(3): 00-00.

(Abstract Text HTML)     (Download PDF)

Tags: , , , ,