Han Xinqiang, Zhang Yongzhen, Wang Zhu, Zhao Mengpeng
Department of Interventional Medicine and Vascular, Binzhou Medical University Hospital, Binzhou, China.
Front Cardiovasc Med. 2022 Sep 29;9:892025. doi: 10.3389/fcvm.2022.892025. eCollection 2022.
Cement leakage into the inferior vena cava (IVC) is one of the most common complications associated with cement vertebroplasty, and can lead to potentially life-threatening complications such as pulmonary cement embolism (PCE). Implantation of an IVC filter is effective in the prevention of fatal pulmonary embolism. Here, we present an extremely rarely case of cement entrapped in an IVC filter after pedicle screw augmentation, and discuss all similar cases reported in the literature.
A 70-year-old female presented with significant back and lower extremities pain and was unable to walk. MRI of the lumbar spine revealed an osteoporotic compression fracture of the L1-L3. She underwent cement-augmented pedicle screws implanted at the L1 and L3 vertebral bodies. A retrievable IVC filter was implanted due to the presence of calf vein thrombosis before cement vertebroplasty. Cement leaked into the IVC and was trapped by the filter, rendering the filter unretrievable using a conventional method. The asymptomatic patient received rivaroxaban 20 mg daily for anticoagulant postoperatively and lifelong anticoagulation was administered to prevent secondary IVC and cemented filter thrombosis.
A literature search was conducted utilizing the PUBMED/MEDLINE using the following terms: "vertebroplasty," "complication," "bone cement," and "inferior vena cava (IVC)," or "inferior vena cava (IVC) filter." All relevant articles published in English or in other languages with English abstracts since 1962 were included.
A total of 36 articles were retrieved according to the search strategy. Only 6 out of these 36 studies contained information regarding the inferior vena cava filter and cement. Of the patients, 85.7% (36/42) reported in the literature whose gender was known were female and 14.3% were male. 28.5% (45/158) patients with pulmonary arterial and cardiovascular complications.
Cement embolization occurring in the IVC filter is rare. Accurate knowledge about the lumbar vertebral venous anatomy and skillful operation during vertebral cementoplasty should be required in clinical practice.
骨水泥渗漏至下腔静脉（IVC）是椎体成形术中最常见的并发症之一，可导致潜在的危及生命的并发症，如肺骨水泥栓塞（PCE）。植入下腔静脉滤器对预防致命性肺栓塞有效。在此，我们报告1例椎弓根螺钉强化术后骨水泥被困于下腔静脉滤器内的极其罕见病例，并讨论文献中报道的所有类似病例。
一名70岁女性，出现严重的腰背部及下肢疼痛，无法行走。腰椎MRI显示L1-L3椎体骨质疏松性压缩骨折。她接受了L1和L3椎体的骨水泥强化椎弓根螺钉植入术。由于在椎体成形术前存在小腿静脉血栓形成，植入了可回收的下腔静脉滤器。骨水泥渗漏至下腔静脉并被滤器捕获，导致无法使用传统方法取出滤器。该无症状患者术后接受每日20mg利伐沙班抗凝治疗，并给予终身抗凝以预防继发性下腔静脉及骨水泥化滤器血栓形成。
利用PUBMED/MEDLINE进行文献检索，检索词如下：“椎体成形术”、“并发症”、“骨水泥”和“下腔静脉（IVC）”或“下腔静脉（IVC）滤器”。纳入自1962年以来发表的所有英文或带有英文摘要的其他语言的相关文章。
根据检索策略共检索到36篇文章。这36项研究中只有6项包含有关下腔静脉滤器和骨水泥的信息。在文献报道的已知性别的患者中，85.7%（36/42）为女性，14.3%为男性。28.5%（45/158）的患者出现肺动脉和心血管并发症。
骨水泥栓塞发生在下腔静脉滤器内很罕见。临床实践中应准确了解腰椎静脉解剖结构并在椎体骨水泥成形术中熟练操作。
