Cement-augmented fenestrated
pedicle screw fixation is becoming more popular for osteoporotic patients. Although several reports have been published on leakage-related problems with
bone cement, no cases of cardiac perforation after cement-augmented
pedicle screw fixation have been reported. We present a case of cardiac perforation after cement-augmented fenestrated
pedicle screw fixation. A 67-year-old female was admitted to our hospital with complaints of
dyspnea and
chest pain after lumbar surgery. She had been treated with L4-5 lumbar interbody fusion and percutaneous
pedicle screw fixation with
bone cement augmentation seven days earlier for degenerative
spondylolisthesis. The right
chest pain was observed a day after the surgery; she was treated conservatively but it did not improve for 7 days after surgery. Chest computed tomography (CT) revealed a
hemothorax and a large sharp
bone cement fragment that perforated the right atrium.
Bone cement can be removed with
thoracotomy surgery. We have to be aware of cement leakage through the normal venous drain system around the vertebral body. We also have to consider a detailed cardiac workup, which may include chest CT or echocardiography, if a patient complains of
chest pain or
dyspnea after cement augmentation.