Clinical Practice and Cases in Emergency Medicine

Introduction: Vertebral augmentation procedures, including vertebroplasty and kyphoplasty, can result in cement extravasation, which is often clinically silent. Less commonly, cement may migrate intravascularly into the inferior vena cava (IVC) and pulmonary arterial circulation, resulting in pulmonary cement embolism, a potentially life-threatening complication. Early recognition in the emergency department (ED) is essential to guide appropriate imaging, specialty consultation, and timely management.

Case Report: A 76-year-old woman with recent third lumbar vertebral augmentation presented to the ED with acute worsening low back pain and burning bilateral radicular symptoms approximately one week after the procedure. Computed tomography (CT) of the abdomen and pelvis with intravenous contrast demonstrated linear hyperdense material extending from the treated vertebral body into the IVC, concerning for intravascular cement migration. Additional CT of the chest demonstrated multiple bilateral subsegmental pulmonary cement emboli. Interventional radiology was consulted emergently, and the patient was transferred for endovascular retrieval of the IVC cement fragment, which was successfully removed. The pulmonary cement emboli were small, peripheral, and asymptomatic and were managed conservatively. The patient remained hemodynamically stable and was discharged after monitored hospitalization.

Conclusion: Inferior vena cava cement migration with pulmonary cement embolism is a potentially life-threatening complication of vertebral augmentation. Emergency physicians should maintain suspicion for this diagnosis in patients with acute pain or new cardiopulmonary symptoms following recent spinal procedures. Early imaging, multidisciplinary consultation, monitored admission, and endovascular retrieval when indicated may reduce morbidity.