Segmental polimetilmetakrilat ile güçlendirilmiş pedikül vidası kullanımı sonrası gelişen pulmoner sement embolisi

75 yaşında bayan hastada 2 ay önce düşme sonucu sırt-bel ağrısı, ayakta duramama, yürüyememe, her iki bacak ağrısı ve idrar kaçırma gelişmiştir. Hastada L1 omurgada osteoporotik vertebra kompresyon kırığı, epidural bası ve L3-4 seviyesinde dar kanal saptanmıştır. Hastaya T12-L2 seviyelerine posteriordan stabilizasyon (pedikül vidaları osteoporoz nedeniyle polimetilmetakrilat ile güçlendirildi) ve füzyon, L1 ve L3 total laminektomi ve bilateral foraminotomi uygulanmıştır. Ameliyat sonrası 1.gün hafif ateş, göğüs ağrısı ve nefes darlığı şikayeti gelişen hastanın torakal bilgisayarlı tomografisi ve pulmoner bilgisayarlı tomografi anjiyografisinde trunkus pulmonalis, sağ pulmoner arter ve orta lob pulmoner arter dallarında ve azigos vende sement embolisi tespit edilmiş ve heparin başlanmış ve hasta daha sonra kumadinize edilmiştir. 3 ay kumadin kullanan hastanın semptomları gerilemiştir. 1 yıl kontrolünde sorun olmadığı görülmüştür. Sonuç olarak, sement embolisi vertebroplasti uygulanan vakalara görüleceği gibi, polimetilmetakrilat ile güçlendirilmiş pedikül vidası uygulamalarında da gelişebileceği akılda tutulması fikri elde edilmiştir

Pulmonary cement embolism after segmental polymethylmethacrylate-augmented pedicle screw fixation

75 year-old female patient admitted to the hospital with complaints of low-back pain started after a fall 2 months ago, inability to stand and walk bilateral leg pain and urinary incontinence. L1 vertebra osteoporotic compression fracture, epidural compression and lomber spinal stenosis at L3-4 level were diagnosed. T12-L2 posterior stabilization with polymethylmetacrylate augmented pedicle screw system and fusion, L1 and L3 total laminectomy and bilateral foraminotomy was done. At the 1st day after the operation, she had slight fever, chest pain and breathing difficulty. Thorax computerized tomography and angiography revealed cement emboli at truncus pulmonalis, right pulmoner artery and middle lobe pulmoner artery segments and azygos vein. Heparin treatment started immediately and patient received coumadin for 3 months. 1 year postoperative, she was symptom-free. As a conclusion, like vertebroplasty, pulmoner cement emboli should be considered after PMMA augmented pedicle screw augmentation

Kaynakça

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