Audat Ziad A, Alfawareh Mohammad D, Darwish Fayeq T, Alomari Ali A
Department of Orthopedic, King Abdullah University Hospital, Irbid, Jordan.
Department of Neuroscience, King Fahd Medical City, Riyadh, Saudi Arabia.
Am J Case Rep. 2016 May 13;17:326-30. doi: 10.12659/ajcr.897719.
Intracardiac leakage of bone cement after kyphoplasty and vertebroplasty is a rare and life-threatening complication. Cortoss, which is an injectable, non-absorbable, polymer composite that is designed to mimic cortical bone, can be used instead of cement. Here, we present the case of a patient with right intra-cardiac Cortoss embolization.
A 28-year-old man known to have ulcerative colitis since the age of 15 and treated with corticosteroids for more than 4 years and with anti-immune drugs presented to our hospital complaining of back pain and decreased body height due to osteomalacia with failed conservative treatment. Kyphoplasty and vertebroplasty of the thoracic 10-12 and first lumbar vertebrae were done with any complications. Three months later, the patient underwent kyphoplasty and vertebroplasty of lumbar 2-5 vertebrae by injecting Cortoss instead of cement, which was complicated with paravertebral intravascular leakage. We stopped surgery and transferred him to the recovery room, where he had slight chest pain that resolved spontaneously without neurological deficit. Two days later he developed severe chest pain and chest X-ray showed a large white shadow at the right side of the heart and another 2 small shadows just lateral to it. Sudden deterioration of patient status necessitated an emergency echocardiogram, which showed pericardial tamponade and a perforated right ventricle. Aspiration of pericardial blood and emergency open heart surgery were done. He was discharged 4 days later and was followed up at an outpatient clinic.
Cardiac embolism is a serious condition that can complicate vertebral kyphoplasty; it requires a high level of suspicion and immediate action, and may need open heart surgery to save the patient's life.
椎体后凸成形术和椎体成形术后骨水泥心内渗漏是一种罕见且危及生命的并发症。Cortoss是一种可注射、不可吸收的聚合物复合材料，旨在模拟皮质骨，可用于替代骨水泥。在此，我们报告一例右心内Cortoss栓塞患者的病例。
一名28岁男性，自15岁起患有溃疡性结肠炎，接受皮质类固醇治疗4年以上，并使用免疫药物，因骨质疏松症保守治疗失败，出现背痛和身高降低，前来我院就诊。对第10 - 12胸椎和第一腰椎进行了椎体后凸成形术和椎体成形术，未出现任何并发症。三个月后，患者对第2 - 5腰椎进行椎体后凸成形术和椎体成形术，注射Cortoss而非骨水泥，出现椎旁血管内渗漏并发症。我们停止手术，将他转移至恢复室，在那里他有轻微胸痛，自行缓解，无神经功能缺损。两天后，他出现严重胸痛，胸部X线显示心脏右侧有一个大白影，其外侧还有另外两个小阴影。患者病情突然恶化，需要紧急超声心动图检查，结果显示心包填塞和右心室穿孔。进行了心包血液抽吸和紧急心脏直视手术。4天后他出院，并在门诊进行随访。
心脏栓塞是一种严重疾病，可使椎体后凸成形术出现并发症；需要高度怀疑并立即采取行动，可能需要进行心脏直视手术以挽救患者生命。
