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Vertebroplasty Cement Embolism Risk — FRCA Final MCQ

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ModerateGeneral AnaesthesiaVertebroplasty Cement Embolism RiskFRCA Final

A 68-year-old woman (ASA III) with osteoporosis and previous vertebral fractures has chronic back pain. She is referred for a vertebroplasty. What is the main risk specific to percutaneous vertebroplasty that the anaesthetist should be prepared for?

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Reveal the answer and explanation

Correct answer: A — Anaphylaxis to contrast dye only

Percutaneous vertebroplasty involves injection of polymethylmethacrylate (PMMA) bone cement into a collapsed vertebral body under fluoroscopic guidance. The main specific risk is cement embolism: liquid cement can leak into the vertebral venous plexus and embolise to the pulmonary vasculature, causing pulmonary cement embolism. This can range from asymptomatic to fatal cardiovascular collapse. The anaesthetist must monitor for: sudden hypoxia, hypotension, elevated PA pressures, and cardiovascular collapse during and immediately after cement injection. Other risks include: cement leakage into the spinal canal (cord compression), adjacent vertebral fracture, and local infection.

Reference: NICE – 2003 – IPG12 Vertebroplasty; RCOA – 2023 – Spinal surgery anaesthesia