J Minim Invasive Spine Surg Tech.  2025 Jan;10(Suppl 1):S98-S103. 10.21182/jmisst.2024.01487.

Unilateral Biportal Endoscopic Management of Cement Leakage After Cement-Augmented Pedicle Screw Fixation: A Technical Report

• Moon K
• Kim JS
• Kim WJ

• KMID: 2566287
• DOI: http://doi.org/10.21182/jmisst.2024.01487

Abstract

With the growth of the population of older adults, cement-augmented pedicle screws (CAPS) have become more commonly employed. Although CAPS are considered safe, cement leakage can occur, leading to complications. Neurological symptoms resulting from bone cement leakage pose significant challenges in both diagnosis and treatment. Unilateral biportal endoscopy (UBE) offers a minimally invasive solution for these issues. UBE enables a thorough exploration of potential compression sites, allowing precise visualization of the entire nerve roots without necessitating removal of the instrument or compromising spinal stability. Additionally, it facilitates the removal of cement fragments under direct vision. Herein, we present the case of an 84-year-old female patient who underwent endoscopic interbody fusion of L4–5. After surgery, she presented with radiating pain in the right lower extremity. Postoperative magnetic resonance imaging indicated indirect evidence of cement leakage under the right L5 pedicle screw. The patient underwent UBE exploration under spinal anesthesia. During the procedure, the cement fragment was detected and removed without complication. UBE can also be performed under local or regional anesthesia, significantly reducing the anesthetic risk for medically fragile individuals. Using UBE, it is also possible to monitor neurological function while manipulating the neural tissue. UBE is a viable option for both the diagnosis and treatment of cement leakage following CAPS placement.

Keyword

Unilateral biportal endoscopy; Cement-augmented screw fixation; Cement leakage; Minimally invasive spine surgery