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Cardiac Perforation Caused by Bone Cements as a Complication of Cement Augmented Pedicle Screw Fixation Using the Fenestrated Pedicle Screw: A Case Report

Korean Journal of Neurotrauma 2020년 16권 2호 p.337 ~ 342
홍성욱, 오탁혁, 전재민, 이영석, 김경태,
소속 상세정보
홍성욱 ( Hong Seong-Wook ) - Kyungpook National University School of Medicine Kyungpook National University Hospital Department of Anesthesiology and Pain Medicine
오탁혁 ( Oh Tak-Hyuk ) - Kyungpook National University School of Medicine Kyungpook National University Hospital Department of Thoracic and Cardiovascular Surgery
전재민 ( Jeon Jae-Min ) - Kyungpook National University School of Medicine Kyungpook National University Hospital Department of Anesthesiology and Pain Medicine
이영석 ( Lee Young-Seok ) - Kyungpook National University School of Medicine Kyungpook National University Chilgok Hospital Department of Neurosurgery
김경태 ( Kim Kyoung-Tae ) - Kyungpook National University College of Medicine Kyungpook National University Hospital Department of Neurosurgery

Abstract


Cement-augmented fenestrated pedicle screw fixation is becoming more popular for osteoporotic patients. Although several reports have been published on leakage-related problems with bone cement, no cases of cardiac perforation after cement-augmented pedicle screw fixation have been reported. We present a case of cardiac perforation after cement-augmented fenestrated pedicle screw fixation. A 67-year-old female was admitted to our hospital with complaints of dyspnea and chest pain after lumbar surgery. She had been treated with L4?5 lumbar interbody fusion and percutaneous pedicle screw fixation with bone cement augmentation seven days earlier for degenerative spondylolisthesis. The right chest pain was observed a day after the surgery; she was treated conservatively but it did not improve for 7 days after surgery. Chest computed tomography (CT) revealed a hemothorax and a large sharp bone cement fragment that perforated the right atrium. Bone cement can be removed with thoracotomy surgery. We have to be aware of cement leakage through the normal venous drain system around the vertebral body. We also have to consider a detailed cardiac workup, which may include chest CT or echocardiography, if a patient complains of chest pain or dyspnea after cement augmentation.

키워드

Bone cement augmentation; Fenestrated pedicle screw; Cement leakage; Hemothorax; Cardiac perforation

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