Management of pulmonary cement embolism after percutaneous vertebroplasty and kyphoplasty: a systematic review of the literature

Eur Spine J. 2009 Sep;18(9):1257-65. doi: 10.1007/s00586-009-1073-y. Epub 2009 Jul 4.


Balloon kyphoplasty and percutaneous vertebroplasty are relatively recent procedures in the treatment of painful vertebral fractures. There are, however, still some uncertainties about the incidence and treatment strategies of pulmonary cement embolisms (PCE). In order to work out a treatment strategy for the management of this complication, we performed a review of the literature. The results show that there is no clear diagnostic or treatment standard for PCE. The literature research revealed that the risk of a pulmonary embolism ranges from 3.5 to 23% for osteoporotic fractures. In cases of asymptomatic patients with peripheral PCE we recommend no treatment besides clinical follow-up; in cases of symptomatic or central embolisms, however, we recommend to proceed according to the guidelines regarding the treatment of thrombotic pulmonary embolisms, which includes initial heparinization and a following 6-month coumarin therapy. In order to avoid any types of embolisms, both procedures should only be performed by experienced surgeons after critical determination of the indications.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Anticoagulants / therapeutic use
  • Bone Cements / adverse effects*
  • Humans
  • Osteoporosis / complications
  • Patient Selection
  • Postoperative Complications / chemically induced
  • Postoperative Complications / physiopathology
  • Postoperative Complications / therapy
  • Pulmonary Embolism / chemically induced*
  • Pulmonary Embolism / drug therapy*
  • Pulmonary Embolism / physiopathology
  • Spinal Curvatures / etiology
  • Spinal Curvatures / prevention & control
  • Spinal Curvatures / surgery*
  • Spinal Fractures / complications
  • Spinal Fractures / surgery*
  • Vertebroplasty / adverse effects*
  • Vertebroplasty / methods


  • Anticoagulants
  • Bone Cements