B64-42 Not Your Typical Pulmonary Embolus: Cement Migration After Spinal Fusion Surgery

Abstract Introduction Pulmonary cement embolism (PCE) is a rare but increasingly recognized complication associated with vertebral augmentation procedures and extensive spinal instrumentation. While often asymptomatic, PCE may present with dyspnea, hypoxia, chest pain, and hemodynamic instability. We describe a case of symptomatic PCE in a patient following extensive spinal fusion and vertebral column resection, complicated by concurrent pulmonary thromboembolism and acute cardiomyopathy. Case Presentation A 67-year-old male with an extensive history of spinal surgeries, including cervical and thoracic fusions with multiple revisions, presented with worsening thoracic back pain and drainage from a recent incision. He had undergone a C4-T8 posterior fusion with T4 vertebral column resection three weeks earlier for a traumatic T5 fracture. Imaging revealed a postoperative fluid collection, and he underwent wound debridement and washout. Cultures grew gram-positive cocci, and antibiotic therapy was initiated. His hospital course was complicated by multiple upper extremity deep vein thromboses associated with a peripherally inserted central catheter. Anticoagulation was initially withheld due to ongoing surgical drainage, but was later resumed with a heparin infusion once a new central line was placed. Shortly thereafter, the patient developed acute shortness of breath, hypoxia, and tachycardia, prompting an emergent CT pulmonary angiogram. Imaging revealed cement within the pulmonary arteries of the lingula, consistent with pulmonary cement embolism, along with segmental pulmonary thromboembolism and surrounding infarction. The patient was transferred to the intensive care unit for further management, including supportive oxygen therapy. Subsequent echocardiography demonstrated new-onset severe left ventricular systolic dysfunction with an ejection fraction of less than 20%. Cardiology initiated guideline-directed medical treatment for heart failure. Over the following days, his oxygen requirements improved, and he was successfully weaned to room air. The patient completed intravenous antibiotic therapy and was ultimately discharged home in stable condition with close outpatient follow-up. Discussion This case highlights symptomatic PCE following complex spinal reconstruction. Cement migration is most often associated with vertebroplasty and kyphoplasty; however, PCE can also occur during multilevel fusion and vertebral column resection. Presentation can mimic thromboembolism, complicating diagnosis and management. CT angiography is the preferred diagnostic modality, and management is individualized based on symptom severity, embolus burden, and concurrent thromboembolism. This case underscores the importance of recognizing PCE in postoperative spine patients presenting with respiratory compromise and highlights the need for heightened vigilance during high-risk spinal instrumentation procedures. This abstract is funded by: None