Minimally invasive transforaminal endoscopic treated neurologic deficit after percutaneous kyphoplasty-a case report

Although iatrogenic neurologic injuries are infrequent after percutaneous kyphoplasty (PKP), the consequence is ruinous. Previous reports confirmed that acute neurologic deficit could mainly be attributed to cement extravasation into the spinal canal, resulting in the compression of spinal cord and nerve foot. Herein, we present a case of using percutaneous transforaminal endoscopy to relieve nerve compression which caused by the fracture of superior articular process after PKP. A 67-year-old male patient was admitted to our hospital with leg radiculopathy and weakness of extensor digitorum longus three weeks after PKP. CT detected the fracture of superior articular process of L4, and confirmed that fracture fragment compressed nerve root of L4. The patient was treated using a minimally invasive transforaminal endoscopic approach, with an indirect decompression of the nerve root performed by removing the posterior border of the L4 vertebra, along the direction of the affected nerve root. The approach was successful, with the patient remaining symptom free at 1-year post-surgery. We propose that transforaminal endoscopic surgery can provide a suitable alternative for the treatment of spinal cord and/or nerve root compression after PKP in selected cases.