An unusual case study is in The New England Journal of Medicine (warning, graphic images of surgery in that link) describes a 56-year-old man who had had an extremely rare complication from surgery on his spinal cord that led to one of his arteries becoming blocked with cement. Fortunately, he recovered all right.
The patient had a vertebral compression fracture in his lower back. The man’s L5 vertebra, located just above the sacrum, was the subject of a procedure called kyphoplasty. To repair a broken vertebra, a special type of cement – polymethylmethacrylate medical cement – is injected into the bone. This allows the vertebra to return to its original height and relieve the patient of pain.
Any medical intervention has its risks – although not common, one risk associated with this and similar procedures is the cement leaking into surrounding tissues. This is what happened to this particular patient.
About five days after the spinal procedure, the man began experiencing chest pain, radiating to the jaw and shoulder on the right side of his body. After two days of pain, he returned to the hospital where he was given an x-ray and a computed tomography (CT) scan of his chest. The foreign body in an artery was then discovered.
The patient was immediately taken to surgery and underwent an emergency cardiothoracic procedure. That’s when the surgeons were able to assess the extent of the damage. The medical cement had accumulated and solidified into an embolism 10.1 centimeters (4 inches) in length and 2 millimeters in diameter. However, that wasn’t the full extent of the damage.
The foreign body ended up perforating the right atrium, the first chamber where venous blood coming from the rest of the body gets into the heart, before moving to the right ventricle and being sent to the lungs to get rid of carbon dioxide and get oxygen. The embolism did not stop there, pushing past the pericardium – the sac that surrounds the heart – and puncturing his right lung.
Luckily, the surgery was a success. The cement embolus was removed and the damage to the heart was repaired. The patient did not suffer from any post-operative complication and a month since the procedure has almost completely recovered.