A patient with a fractured spine sued her doctor for malpractice after two vertebroplasty procedures allegedly became life-threatening. The medical records indicated that about 6 ml of cement was used during the procedure to restore her fractured vertebra. Hours later, the patient returned to the hospital complaining of nausea and shortness of breath, and scans revealed that she had developed solid masses on both sides of her chest. The masses were recorded to be consistent with possible blockages of cement, and had caused pulmonary edema and a possible developing obstruction of blood flow to vital organs. The patient became hypotensive, and an emergency echocardiogram showed that she had developed a mitral regurgitation. Her body became deprived of oxygen, and an immediate application of airway pressure release ventilation began to encourage improvement. Eventually, she had to undergo a series of complex heart surgeries at a specialized facility, and her condition did not improve until over a year after her original vertebroplasty procedures.
Question(s) For Expert Witness
- 1. Do you routinely treat patients similar to the one described in the case?
- 2. What is the acceptable amount of surgical cement allowed for a patient such as the one described in the case summary? Could there be any complications if too much is used?
Expert Witness Response E-007445
I routinely treat patients with vertebroplasty for pathologic fractures similar to the one in this patient. The outcome described in this case is a highly unusual complication of the procedure; I have never had such an outcome in almost 2000 cases. Generally, there is no “standard” amount of cement, as this depends on the spinal level treated, the size of the lesion, the physician’s expertise, and the number of treated fractures.
Expert Witness Response E-030292
I was one of the original doctors who invented vertebroplasty and I have performed thousands of them. The complications in this case are exceptional, and I would need to know more about the procedure before commenting fully.