Unilateral biportal endoscopic transpedicular intrabody cage augmentation for a metastatic spinal tumor with pathologic fracture: a technical note and case report.

INTRODUCTION

Metastatic spinal tumors (MSTs) may cause pathologic burst fractures with severe pain and neurologic compromise, often requiring circumferential decompression and anterior column reconstruction. Traditional open corpectomy is associated with substantial surgical morbidity. Transpedicular intrabody augmentation has emerged as a minimally invasive alternative; however, an endoscopic approach using UBE for oncologic anterior reconstruction has not been well described.

CLINICAL PRESENTATION: A 73-year-old man with polymetastatic colon cancer presented with debilitating axial back pain, bilateral lower-extremity weakness (motor grade 3), and radiculopathy due to an L2 metastatic burst fracture. He underwent percutaneous posterior screw fixation (T12-L4) followed by UBE-assisted transpedicular tumor resection and partial corpectomy. A transpedicular corridor was created through a unilateral laminotomy, enabling ventral tumor removal under direct endoscopic visualization. An expandable titanium cage was inserted and expanded for anterior support while preserving the posterior ligamentous complex.

RESULTS

Ventral decompression and anterior column support were achieved through a posterior-only UBE-assisted transpedicular approach. The patient experienced immediate pain relief, ambulated on postoperative day 1 with motor strength improving to grade 4 + , and reported marked pain improvement by postoperative day 7 (NRS 1). Postoperative imaging confirmed satisfactory cage position; ambulation was maintained until death from systemic disease progression at 2 months.

CONCLUSION

This case suggests that UBE-assisted transpedicular intrabody cage augmentation is technically feasible in a carefully selected patient with a metastatic pathologic burst fracture requiring ventral decompression and anterior support. Further experience and longer follow-up are needed to clarify its safety, durability, and role relative to established surgical approaches.

STUDY

DESIGN

Technical case report.