endplatelekkage

Endplatelekkage, or endplate leakage, is the unintended passage of fluids, cement, or other injected substances through the vertebral endplates into adjacent structures. The term is most often used in the context of procedures that involve injection into the vertebral body, such as vertebroplasty or kyphoplasty for vertebral compression fractures, but can also describe leakage observed during diagnostic injections or other injections into the vertebral region.

Causes and pathways include compromised endplate integrity due to fracture, osteoporosis, or degenerative changes. When injected material is introduced under pressure, it can escape through cracks or defects in the endplate and migrate into neighboring areas such as the intervertebral disc space, paraspinal soft tissues, the venous plexus, or, in rare cases, the spinal canal. Cement leakage is the most commonly reported form, and leakage into the disc space has been associated with accelerated adjacent-segment degeneration in some cases. Vascular leakage can lead to embolic events, including pulmonary embolism.

Clinical significance varies. Many leaks are asymptomatic and discovered only on imaging. However, leakage into the spinal canal or neural foramina can cause neurologic symptoms, while leakage into the disc space or soft tissues may contribute to pain or infection in rare circumstances. The risk and impact depend on the volume and location of the leakage.

Detection and evaluation typically rely on real-time imaging during procedures (fluoroscopy or CT guidance) and post-procedure imaging (X-ray, CT, or MRI) to characterize the extent and location of leakage. Management ranges from careful observation for asymptomatic leaks to targeted intervention for symptomatic or hazardous leaks, with treatment guided by leak location and patient status. Prevention focuses on meticulous technique, appropriate material viscosity, controlled injection, and real-time imaging to minimize extrusion.