Background: Intraspinal cement leakage is a catastrophic complication of percutaneous
vertebroplasty (PVP). Percutaneous endoscopic spinal surgery (PESS) for intraspinal cement leakage
has rarely been reported.
Objectives: To evaluate the therapeutic effectiveness of PESS for intraspinal cement leakage
following PVP.
Study Design: This was a retrospective study approved by the ethics committee of our institution.
Setting: Department of Orthopedics from an affiliated hospital.
Methods: Twelve patients with neurologic impairments resulting from intraspinal cement
leakage after PVP were treated with PESS for spinal decompression from May 2014 to June 2018.
Computed tomography and 3-dimensional reconstruction were used to confirm the vertebral level
of cement leakage. The surgical index, neurologic function, and clinical results were recorded in
this study.
Results: The leaked cement of all patients was successfully removed under PESS, and no severe
intraoperative complications were reported in our study. The operation time ranged from 43 to
119 minutes (mean, 65.5 minutes). The amount of intraoperative blood loss was 64.25 ± 9.62 mL.
The lengths of postoperative hospital stays were 5.25 ± 2.53 days. The follow-up rate was 83.3%
(10/12). The follow-up time ranged from 14 to 30 months (mean, 22 months). The Visual Analog
Scale scores of foraminal leaks improved from 6.50 ± 0.93 preoperatively to 1.75 ± 0.71 at the last
follow-up (P < 0.05). Neurologic function was evaluated by Japanese Orthopaedic Association 29
scores, which improved from 18.75 ± 1.06 to 22.70 ± 1.64 (P < 0.0001). The good and excellent
rates were 80% according to the modified Macnab criteria.
Limitations: This study is limited by the volume of patients and the deep learning curve needed
for PESS.
Conclusions: PESS, as a minimally invasive technique, can achieve targeted spinal cord
decompression and may be a safe and effective alternative approach to conventional procedures
for cement leakage after PVP.
Key words: Endoscopes, cement leakage, minimally invasive surgery, percutaneous vertebroplasty