ABSTRACT

A 75-year-old female patient was admitted to hospital with complaints of lower back pain that began after a fall two months previously, an inability to stand and walk, bilateral leg pain, and urinary incontinence. An L1 vertebral osteoporotic compression fracture, epidural compression and lumbar spinal stenosis at the L3–4 level were diagnosed. T12–L2 posterior stabilization with a polymethyl methacrylate-augmented pedicle screw system and fusion, L1 and L3 total laminectomy and bilateral foraminotomy were carried out. On the first day after surgery she had a slight fever, chest pain and breathing difficulty. Thorax computerized tomography and angiography revealed cement emboli at the truncus pulmonalis, right pulmonary artery and middle lobe pulmonary artery segments, and azygos vein. Heparin treatment was started immediately, the patient received coumadin, and the symptoms regressed after three months. One year postoperatively, she was symptom-free. As a result, as with vertebroplasty, pulmonary cement emboli should be considered after a PMMA-augmented pedicle screw augmentation.