Severe hypercapnia due to pulmonary embolism of polymethylmethacrylate during vertebroplasty

Anesth Analg. 2004 Apr;98(4):1184-1186. doi: 10.1213/01.ANE.0000104585.83801.C5.


Pulmonary polymethylmethacrylate embolism is a rare but potentially fatal complication of percutaneous vertebroplasty. Clinical signs are typical for pulmonary embolism: they include respiratory distress, hypotension, and decreases in end-tidal CO(2). We report a case of fatal pulmonary polymethylmethacrylate embolism during percutaneous vertebroplasty that initially presented with hypertension (arterial blood pressure 190/90 mm Hg), normocardia, and hypercapnia (PaCO(2) 96 mm Hg), along with loss of consciousness. Several pieces of polymethylmethacrylate were found in the pulmonary vasculature at autopsy.

Implications: Osteoporotic spine fractures are increasingly treated by injection of bone cement into the vertebral body. Polymethylmethacrylate embolism is a rare but potentially fatal complication. We report on a case of polymethylmethacrylate embolism that was at first unrecognized because of uncharacteristic signs and symptoms.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Bone Cements / adverse effects*
  • Echocardiography
  • Fatal Outcome
  • Female
  • Humans
  • Hypercapnia / diagnostic imaging
  • Hypercapnia / etiology*
  • Hypercapnia / physiopathology
  • Lumbar Vertebrae / surgery*
  • Osteoporosis / complications
  • Polymethyl Methacrylate / adverse effects*
  • Pulmonary Embolism / complications*
  • Pulmonary Embolism / diagnostic imaging
  • Pulmonary Embolism / etiology
  • Spinal Fractures / surgery*


  • Bone Cements
  • Polymethyl Methacrylate