Surgical findings and precautions for removing cement that leaked into the spinal canal due to balloon kyphoplasty: illustrative cases.

backgroundBalloon kyphoplasty (BKP) is a widely utilized procedure for osteoporotic and metastatic vertebral fractures. However, cement leakage into the spinal canal is a serious complication that can result in neurological deficits, requiring timely and precise surgical intervention. OBSERVATIONS: This report presents two illustrative cases of BKP-related cement leakage. The first case involved a 52-year-old man with a metastatic L3 fracture, in which cement leaked into the spinal canal. Surgical intervention included L2 and L3 laminectomy, resulting in successful cement removal without neurological deficits. The second case involved an 86-year-old man with an L5 osteoporotic burst fracture and cement leakage into the right lateral recess space, causing a unilateral drop foot. An L5 laminectomy performed 3 days later enabled cement removal, although neurological recovery was incomplete, possibly because of nerve compression or thermal injury. In both cases, the cement was brittle and nonadherent to the dura mater, facilitating safe removal. LESSONS: Evaluating cement leakage after cement injection is essential to avoid oversights. Comprehensive preoperative imaging and meticulous planning are crucial due to the variability in cement leakage patterns. Surgical indications and timing require careful consideration, as cement leakage might be asymptomatic in some cases but result in irreversible damage if untreated. https://thejns.org/doi/10.3171/CASE24796.