Kyphoplasty Cement Embolization and Successful Cement Retrieval from Tricuspid Valve Entrapment

This case report details successful percutaneous management of cement embolization, a known complication of kyphoplasty, in a 60-year-old female with osteoporotic compression fractures undergoing T7 and T8 vertebral augmentation. Kyphoplasty, a procedure involving the injection of polymethyl methacrylate (PMMA) cement into the vertebral body, can result in cement leakage with the potential for serious negative outcomes, including pulmonary embolism. In this patient, post-procedure imaging revealed cement extravasation extending into paravertebral veins with embolization terminating in the right ventricle. Traditional treatment options for cement emboli include anticoagulant therapy or operative embolectomy, both of which are either limited in their efficacy, or have significant added risk that must be weighed. However, this report demonstrates the successful use of a percutaneous cement retrieval approach as a viable option for cement retrieval. With retrieval success and the development of an asymptomatic pulmonary embolism, this approach to treatment proved effective in managing the patient's condition without the need for more invasive surgical interventions. This case adds to the current body of literature on cement extravasation in vertebral augmentation procedures, highlighting the importance of careful procedural planning, real-time monitoring, and prompt response to complications. Also, we highlight the use of newer interventional tools that can make cement retrieval more effective.