Current Evidence and Clinical Implications of Full-Endoscopic Spine Surgery for Post-Vertebroplasty Lumbar Radiculopathy: A Comprehensive Review

Abstract: Percutaneous vertebroplasty (PVP) and kyphoplasty relieve pain associated with osteoporotic vertebral compression fractures. However, the underlying heterogeneous mechanisms of new-onset and post-vertebroplasty radiculopathy, together with ambiguous imaging findings, can complicate diagnoses. This review summarizes the etiologies, diagnostic processes, and therapeutic roles of full-endoscopic spine surgery (FESS) in treating radiculopathy after vertebroplasty. A comprehensive search of PubMed, Embase and Cochrane Library was performed using the following terms: (“percutaneous vertebroplasty” OR “kyphoplasty”) AND (“radiculopathy” OR “nerve root compression” OR “foraminal stenosis” OR “cement leakage”) AND (“endoscopic spine surgery” OR “full-endoscopic” OR “percutaneous endoscopic” OR “transforaminal endoscopic” OR “TELF” OR “FESS”). Nine of the 428 retrieved studies met the inclusion criteria and were analyzed for etiology, imaging, technique, anesthesia, and outcomes. All included studies were case reports or small case series, and their methodological quality was assessed using established critical appraisal tools for descriptive research. Cement leakage emerged as the main cause of postvertebroplasty radiculopathy, which is managed using FESS via transforaminal or interlaminar approaches. Most patients experienced pain relief and neurological improvement with low perioperative morbidity rates. Endoscopic exploration under local anesthesia may serve as a valuable diagnostic tool to identify and localize neural compression that remains ill-defined on preoperative imaging. Given the limited and heterogeneous nature of the current evidence, conclusions regarding the safety and effectiveness of FESS should be interpreted with caution. Nevertheless, FESS might serve as a feasible diagnostic and therapeutic option when conventional imaging modalities fail to identify the pain generator. Keywords: cement leakage, endoscopic spine surgery, kyphoplasty, radiculopathy, vertebroplasty