Pulmonary Embolism After Vertebroplasty with Use of Hydroxyapatite Blocks: A Case Report.

Abstract

Pulmonary embolism following vertebroplasty with use of polymethylmethacrylate (PMMA) has been reported in various publications1-3. Pulmonary embolism occurs as a result of extravertebral cement leakage and migration through paravertebral veins and the inferior vena cava4. In Japan, the hydroxyapatite (HA) block is approved as an augmentation material for vertebroplasty with or without instrumentation for osteoporotic vertebral fracture. It has been thought to be relatively safe compared with PMMA in terms of extravertebral leakage because of its solid configuration. We report a rare case of pulmonary embolism following the use of HA blocks during a posterior lumbar vertebroplasty that was combined with a revised arthrodesis. The patient was informed that data concerning the case would be submitted for publication, and she provided consent. A sixty-seven-year-old woman experienced sudden low back pain one month after an L2-L5 posterior decompression and arthrodesis for lumbar canal stenosis. She had a history of systemic lupus erythematosus and had been taking steroids for ten years. Lateral radiographs suggested an osteoporotic vertebral fracture of L5, which was at the lowest level of instrumentation. Computed tomography (CT) demonstrated the L5 vertebral fracture (Fig. 1). Considering the patient’s history of osteoporosis and the difficulty of spontaneous healing of the instrumented vertebral fracture, we planned a revision surgery that included a posterior arthrodesis to the sacrum combined with an L5 vertebroplasty. Fig. 1 Preoperative CT demonstrating the instrumented L5 fracture. The fracture line was seen at the left pedicle and the anterior wall. Under general anesthesia, the patient was placed in the prone position on a Jackson table. After removal of the previously implanted screws and rods, we inserted larger-diameter L2-S1 pedicle screws and S2 alar screws with …