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Large intraspinal cement leak during multilevel cement-augmented screw fixation

© BMJ Publishing Group Limited 2021. No commercial reuse. See rights and permissions. Published by BMJ. DESCRIPTION Cement augmentation of pedicle screws effectively provides adequate anchorage in an osteoporotic spine as it increases the pedicle screw interface and pullout strength. However, there are potential dangers of cement leak (CL) in 11.2%–82.4% of patients. These leaks are intradiscal or extravertebral when they can be asymptomatic, but rarely can there be an intraspinal leak. Even though rare, the leakage of cement into the spinal canal can have devastating consequences. The resulting neurological injury becomes permanent if there is thermal or chemical burn by the cement. Mechanical compression is also theoretically possible. This complication’s standard assessment and management are not very clearly defined, as many cases may be underreported. We describe long intraspinal CL in patients with L1 burst fracture, which spared the spinal cord through immediate decompression. The purpose is to sensitise the readers about this scary complication which can be overwhelming for both the patient and the surgeon.