Fatal fat embolism after vertebroplasty: identification of the high-risk patient

Abstract

We report a rare complication of autopsy-proven fat and bone marrow embolization following percutaneous vertebroplasty in a patient who had no evidence of cement leakage. Cement injection was done during one patient encounter, covering 3 vertebral levels by using a unipedicular approach. Patients may have complications even without polymethylmethacrylate leakage.

Fig 1.

A, Lateral fluoroscopic view showing near-complete filling of T10, T11, T12. B, AP fluoroscopic view showing near-complete filling with leakage into the paravertebral vein and basivertebral venous plexus. There is relative sparing of the right lateral fourth of T10 and T11 and sparing of the right third of T12.

Fig 2.

Microscopic view (200×) of alveoli stained in oil Red-O by using a frozen section highlighting fat emboli. The fat emboli are seen as red dots within capillaries of the lung.

Fig 3.

Hematoxylin-eosin routine stain (200×) showing bone marrow emboli in arteriole. The arrows indicate a bone marrow embolus within an arteriole of the lung. The embolus has hematopoietic cells and fat droplets characteristic of bone marrow.

Fig 4.

Gross specimen of T10, T11, and T12 at autopsy showing no leakage of methylmethacrylate outside of individual vertebrae. Tan areas (arrows) represent cement within the vertebral bodies. Bone marrow is seen as the darker brown segments. The tan bands traversing the specimen are the intervertebral disks.