Incidence, Clinical Characteristics, Treatment and Outcomes of Intracardiac Cement Embolism After Vertebral Augmentation: A Systematic Review.

Abstract

Study DesignSystematic review.ObjectiveIntracardiac cement embolism (ICE), a rare but life-threatening complication of vertebral augmentation (VA), is poorly characterized. Our review summarizes the incidence, clinical characteristics, treatment and outcome of this complication.MethodsMedline, Embase, and Cochrane databases were systematically searched from inception to April 1, 2025. References were cross-checked to identify additional relevant articles. Included publications underwent quality assessment using the Case Report (CARE) Guidelines and the Joanna Briggs Institute (JBI) Critical Appraisal Checklist, with pooled analysis of incidence, clinical characteristics, treatment, and outcomes.Results4 case-series and 96 case reports (181 cases) were included. The overall reporting rate for each study was relatively high, but low reporting rates in 11 sub-items may introduce bias. Among 115 cases with epidemiological data, osteoporotic fractures predominated (n = 83), followed by other diseases (n = 32). The incidence was low, but the exact value was unclear. Common symptoms included dyspnea and chest pain, with onset typically within 48 h postoperatively, though delays of months to 5 years occurred. Diagnosis relied on chest imaging. Treatment was individualized, but most reports lacked objective evidence to guide decisions. Asymptomatic patients required monitoring, while symptomatic ones may need surgery intervention. The outcome was uneventful for all but 10 patients.ConclusionsICE was reported only in case report or case-series. A comparative analysis of pre- and postoperative chest X-ray is recommended for screening, whil<b>e</b> patients with chest discomfort after VA warrant immediate CT imaging. The simplified decision-making flowchart we have developed may provide valuable insights.Systematic Review RegistrationPROSPERO identifier CRD 42023455121.