Asymptomatic diffuse pulmonary embolism caused by acrylic cement: an unusual complication of percutaneous vertebroplasty

Percutaneous vertebroplasty was first performed in 1984. Galibert et al treated a cervical vertebral angioma by percutaneous puncture and injection of polymethylmethacrylate (PMMA) cement into the vertebral body.1 Shortly thereafter vertebroplasty was done also in lytic metastatic bone lesions.2 Vertebroplasty for the treatment of vertebral fractures in osteoporosis has gained fast acceptance in the past two years. Its efficacy is documented in several clinical studies.3,4 However, open questions about indication, technical aspects, and complications remain. We report the first case of extensive but clinically silent cement embolisation into the lungs. A 67 year old man presented with upper abdominal pain. A chest radiograph suggested multiple vertebral fractures as a possible explanation. Magnetic resonance imaging confirmed fresh osteoporotic fractures. The patient was admitted in April 2000 for percutaneous vertebroplasties. After local anaesthesia, the needle was placed transpedicularly into the vertebral bodies. Under fluoroscopic control the cement was injected without any complication in the vertebral bodies T10 and T11 (fig 1A). As the needle was pulled out …