Presentations, management strategies, and outcomes of intracardiac cement embolism following spinal vertebral augmentation: a systematic review of case reports.

BACKGROUND: Intracardiac cement embolism (ICE) is a rare, but potentially life-threatening complication of percutaneous vertebroplasty (PV), percutaneous kyphoplasty (PK), and cement augmented pedicle screw (CAPS) fixation. This systematic review aims to summarise and compare patient presentations, management approaches, and clinical outcomes of ICE. METHODS: PRISMA guidelines were followed. Standard medical databases such as MEDLINE, Embase, Pubmed, and Cochrane Library were searched to find case reports or series on patients with ICE following PV, PK, or CAPS. Data on patient demographics, embolus location, diagnostic modalities, management strategies, and outcomes were recorded. RESULTS: 67 case reports and 2 case series were included with 71 patients in total. 67 patients presented symptomatically with the most common complaints being chest pain and dyspnoea, the other 4 cases were incidentally discovered. Emboli were predominantly found in the right heart and were primarily discovered via echocardiography or computed tomography. Open-heart surgery was the most adopted management strategy (46 cases, 100% retrieval success), especially in complicated symptomatic cases. Endovascular (11 cases, 72% retrieval success) or conservative approaches (14 cases, 2 mortalities) were reserved for asymptomatic cases with smaller emboli or patients not deemed fit for surgery. Reported mortality was low across all patients, but delayed diagnosis was associated with more severe cardiopulmonary complications. Notably, 28 patients presented within the first day postoperatively, indicating an early peak in presentation. CONCLUSIONS: Open-heart surgery seems to be the preferred, most effective intervention for ICE, while endovascular and conservative management were viable in select cases. However, due to the potential for delayed complications, conservative management should be avoided. Earlier diagnosis is imperative for improving patient outcomes and preventing severe complications.