The Journal of Bone and Joint Surgery (American). 2008;90:349-356.
doi:10.2106/JBJS.G.00058
© 2008 The Journal of Bone and Joint Surgery, Inc.
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow [Supplementary Material]
Right arrow Letters to the Editor: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Letters to the Editor are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowReprints and Permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Krebs, J.
Right arrow Articles by Aebli, N.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Krebs, J.
Right arrow Articles by Aebli, N.
Related Collections
Right arrow Basic Science
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Technorati  
What's this?

Influence of Bone Marrow Fat Embolism on Coagulation Activation in an Ovine Model of Vertebroplasty

Jörg Krebs, DVM, PhD1, Stephen J. Ferguson, PhD, PD1, Simon P. Hoerstrup, MD2, Ben G. Goss, PhD3, André Haeberli, PhD4 and Nikolaus Aebli, MD, PhD5

1 MEM Research Center, Institute for Surgical Technology and Biomechanics, Medical Faculty, University of Bern, Stauffacherstrasse 78, 3014 Bern, Switzerland. E-mail address for J. Krebs: jorg.krebs{at}memcenter.unibe.ch
2 Cardiovascular Surgery Research, University of Zürich, Rämistrasse 100 8091 Zürich, Switzerland
3 AO Spine Research Centre, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, QLD 4102, Australia
4 Department for Clinical Research, Thrombosis and Hemostasis Group, University of Bern, Murtenstrasse 35, 3010 Bern, Switzerland
5 Department for Orthopaedic Surgery, Swiss Paraplegic Centre, 6207 Nottwil, Switzerland
Investigation performed at the MEM Research Center, Institute for Surgical Technology and Biomechanics, Medical Faculty, University of Bern, Bern, Switzerland

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from the Wesley Foundation, Brisbane, Australia; the AO Foundation, Davos, Switzerland; and AOSpine, Dübendorf, Switzerland (SRN 02/105). Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Background: Intraoperative cardiovascular deterioration as a result of pulmonary embolization of bone marrow fat is a potentially serious complication during vertebroplasty. The release of fatty material and thromboplastin from the bone marrow cavity during vertebroplasty may activate the coagulation cascade resulting in thrombogenesis, and pharmacological prophylaxis may therefore prevent cardiovascular complications. Thus, the effects of bone marrow fat embolism on coagulation activation during vertebroplasty were investigated with use of an animal model.

Methods: Polymethylmethacrylate was injected into three lumbar vertebrae of six sheep in order to force bone marrow fat into the circulation. Invasive blood pressures and heart rate were recorded continuously until sixty minutes after the last injection. Cardiac output, arterial and mixed venous blood gas parameters, and coagulation parameters were measured at selected time-points. Postmortem lung biopsy specimens were assessed for the presence of intravascular fat.

Results: Embolization of bone marrow fat resulted in a sudden and dramatic increase in mean pulmonary arterial pressure and a decrease in mean arterial blood pressure. There were no significant changes in any coagulation parameter from before the injection to after the injection. Intravascular fat and bone marrow cells were present in all lung lobes.

Conclusions: Injection of polymethylmethacrylate into vertebral bodies caused embolization of bone marrow fat with subsequent transient cardiovascular deterioration, but no changes in coagulation parameters were observed. Thromboembolism did not contribute to the observed cardiovascular changes.

Clinical Relevance: Cardiovascular complications as a result of bone marrow fat embolism should be considered in patients undergoing vertebroplasty. Vertebroplasty with use of polymethylmethacrylate does not appear to activate the coagulation system or cause thromboembolism.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Technorati Technorati    What's this?