Combined unilateral biportal endoscopy-assisted posterior reconstruction and transforaminal endoscopic cave-in decompression for ventral thoracic cement leakage: a case report and technical note

Abstract Background Symptomatic ventral thoracic cement leakage after vertebroplasty is uncommon and difficult to treat through a limited posterior corridor, particularly when tumor-related structural compromise coexists. Case presentation A 70-year-old woman with multiple myeloma and a T11 pathological fracture developed persistent bilateral lower-limb pain, numbness, weakness, and wheelchair dependence after T11 vertebroplasty. Computed tomography and magnetic resonance imaging demonstrated a focal left-ventral cement fragment at T10/11 compressing the thoracic cord. Because the record documented residual axial pain but did not establish the loading-related pattern typical of mechanical instability, the retrospectively estimated Spinal Instability Neoplastic Score was revised to 9 (potentially unstable), a category requiring specialist assessment rather than mandating fixation. The multidisciplinary treatment decision considered focal neural compression, junctional lytic destruction, unilateral posterolateral/pedicle involvement, planned foraminoplasty, active oncologic treatment, and mobilization goals. Right-sided unilateral biportal endoscopy-assisted facet preparation and grafting at T10/11 and T11/12 was followed by left transforaminal cave-in decompression and completion of a T10-T12 five-screw, bilateral-rod construct. Operative time was 217 min, estimated blood loss was 50 mL, and no transfusion or sustained intraoperative monitoring alert occurred. Imaging on postoperative day 3 showed adequate decompression and no new epidural or foraminal cement leakage. Standardized postoperative neurological scores were not prospectively collected. Available records showed that the patient progressed from wheelchair dependence to standing with a brace at discharge and walking slowly with a brace at 3 months, while leg-pain VAS decreased from 8 to approximately 3. Conclusions This single case demonstrates the technical feasibility of combining posterior reconstruction with transforaminal cave-in decompression in a carefully selected patient. It does not establish superiority, comparative safety, or a causal benefit of reconstruction, and longer follow-up and larger studies are required.