[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-407936-105":3,"doc-detail-407936-en":81,"detail-sidebar-cat-0-en-105":97},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","minimally-invasive-robotic-approach-to-treating-cement-leakage-into-the-psoas-a-case-report","Minimally Invasive Robotic Approach to Treating Cement Leakage Into the Psoas - A Case Report","","A 78-year-old woman developed groin and thigh pain, numbness, and hip flexion weakness after prior lumbar and hip surgeries. Imaging identified cement leakage from an L4 cement-augmented screw into the psoas, compressing a lumbar plexus branch. A minimally invasive, robot-assisted spinal procedure using ExcelsiusGPS enabled precise incision planning, safe psoas dissection, and en bloc cement removal, with immediate symptom resolution. Symptomatic intrapsoas cement leakage causing radiculopathy is rare, and robotic guidance supported a safe and accurate intervention.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/minimally-invasive-robotic-approach-to-treating-cement-leakage-into-the-psoas-a-case-report/407936/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/minimally-invasive-robotic-approach-to-treating-cement-leakage-into-the-psoas-a-case-report/407936.png","ImageObject",300,407,{"name":42,"@type":43},"McGucket","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-11-03","2026-09-28",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",10,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What symptoms did the 78-year-old patient experience, and what did imaging show?","Question",{"text":63,"@type":64},"She presented with groin and thigh pain, numbness, and hip flexion weakness. Imaging showed cement leakage from an L4 screw into the psoas compressing a lumbar plexus branch.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"How was the condition treated using a minimally invasive robotic approach?",{"text":68,"@type":64},"A spinal robotic system (ExcelsiusGPS) was used to plan the incision, guide psoas dissection, precisely locate the cement, and enable en bloc cement removal through an approximately 6 cm incision.",{"name":70,"@type":61,"acceptedAnswer":71},"What were the outcomes after surgery?",{"text":72,"@type":64},"Symptoms resolved immediately after the cement was removed. Three months later, hip flexion weakness remained unchanged.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},407936,1790694613,{"code":4,"msg":82,"data":83},"success",{"doc_id":79,"user_id":84,"nickname":42,"user_avatar":85,"doc_module":4,"category_id":86,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":87,"file_id":88,"file_url":89,"file_type":90,"file_size":91,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":33,"language":92,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":93,"faqs":94,"seo_title":95,"seo_description":12,"update_tm":96,"read_time":55,"preview_page_count":4},1236954412713,"https://us-avatar.wpscdn.com/davatar_29158cc5080c5b710cf443261637dec0",7,"Review began 11/23/2025  \nReview ended 11/27/2025  \nPublished 12/01/2025  \n© Copyright 2025  \nMakino et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited.  \nDOI: 10.7759/cureus.98213  \nOpen Access Case Report  \nMinimally Invasive Robotic Approach to Treating Cement Leakage Into the Psoas: A Case Report  \nHiroto Makino 1 , John Choi 2, Raghad Barri 2  \n1. Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama, JPN 2. Orthopaedic Surgery, Spine Ortho Clinic, Mornington, AUS  \nCorresponding author: Hiroto Makino, [hiroto@med.u-toyama.ac.jp](hiroto@med.u-toyama.ac.jp)  \nAbstract  \nA 78-year-old woman developed groin and thigh pain, numbness, and hip flexion weakness. Imaging revealed cement leakage from an L4 screw into the psoas, compressing a lumbar plexus branch. Using a spinal robotic system (ExcelsiusGPS, Globus Medical, Inc., Audubon, PA), a minimally invasive approach enabled precise incision planning, safe psoas dissection, and en bloc cement removal. Symptoms resolved immediately. Symptomatic intrapsoas cement leakage causing radiculopathy is rare, and robotic guidance contributed to a safe, accurate procedure.  \nCategories: Neurosurgery, Orthopedics  \nKeywords: cement-augmented screw, cement leakage, complication, robot-assisted spine surgery, s: lumbar spine disorders  \nIntroduction  \nCement-augmented pedicle screws have become an established technique for improving fixation strength inpatients with osteoporosis or compromised bone quality [1,2] . Although generally effective, this method carries a risk of cement leakage into segmental veins, the spinal canal, and paravertebral soft tissue [3] . Cement leakage into segmental veins is a risk for pulmonary embolism [4], and leakage into the spinal canal or foramen may cause nerve symptoms [5,6], whereas symptomatic leakage into paravertebral soft tissue has not been reported.  \nHere, we describe a unique case of radiculopathy caused by intrapsoas cement leakage from a cementaugmented pedicle screw, successfully treated through a minimally invasive, robot-assisted approach.  \nCase Presentation  \nA 78-year-old woman presented with a three-month history of right thigh and groin pain, numbness, and hip flexion weakness. Her history included several lumbar surgeries, including an L3-4 transforaminal interbody fusion at another hospital seven years before admission, as well as L1-S1 lateral interbody fusion, posterior fusion, and bilateral sacroiliac joint fusion at our hospital two years before admission. She had also undergone bilateral total hip replacement two and three years before admission, respectively. Physical examination revealed hip flexion weakness of 4/5 . Her pain and numbness coincided with the L3 or L4 dermatome. Radiographic and computed tomography (CT) images (Figure 1) showed cement leakage around a right L4 screw within the right psoas. Magnetic resonance imaging showed no other findings accounting for her symptoms. We chose to perform cement removal. For a minimally invasive procedure, we used a three-dimensional navigation robotic system with an ExcelsiusGPS (EGPS) (Globus Medical, Inc., Audubon, PA) to determine the optimal skin incision and guide psoas dissection.  \nHow to cite this article  \nMakino H , Choi J , Barri R (December 01 , 2025) Minimally Invasive Robotic Approach to Treating Cement Leakage Into the Psoas: A Case Report.  \nCureus 17(12): e98213. DOI 10.7759/cureus.98213  \nFIGURE 1 : Preoperative images: (A) anteroposterior (AP) X-ray; (B) lateral X-ray; (C) coronal computed tomography (CT) image; (D) axial CT image (arrowheads indicating the leaked cement) .  \nThe patient was placed in the left decubitus position in the CT gantry. The reference was inserted into the posterior superior iliac spine. Intraoperative CT was acquir","cbCaimA2OSE9VPkh","https://ap.wps.com/l/cbCaimA2OSE9VPkh","pdf",2144112,"English","# Abstract\n# Introduction\n# Case Presentation\n# Figures\n# Discussion","[{\"question\":\"What symptoms did the 78-year-old patient experience, and what did imaging show?\",\"answer\":\"She presented with groin and thigh pain, numbness, and hip flexion weakness. Imaging showed cement leakage from an L4 screw into the psoas compressing a lumbar plexus branch.\"},{\"question\":\"How was the condition treated using a minimally invasive robotic approach?\",\"answer\":\"A spinal robotic system (ExcelsiusGPS) was used to plan the incision, guide psoas dissection, precisely locate the cement, and enable en bloc cement removal through an approximately 6 cm incision.\"},{\"question\":\"What were the outcomes after surgery?\",\"answer\":\"Symptoms resolved immediately after the cement was removed. Three months later, hip flexion weakness remained unchanged.\"}]","Minimally Invasive Robotic Approach to Treating Cement Leakage Into the Psoas - A Case Report | PDF",1790576949,{"code":4,"msg":82,"data":98},[99,103,107,111,116,121,124,129,134,137,140],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":100,"show_sort_weight":101,"slug":102},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":104,"show_sort_weight":105,"slug":106},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":108,"show_sort_weight":109,"slug":110},"Exam",70,"exam",{"id":112,"doc_module":4,"doc_module_name":25,"category_name":113,"show_sort_weight":114,"slug":115},5,"Comic",60,"comic",{"id":117,"doc_module":4,"doc_module_name":25,"category_name":118,"show_sort_weight":119,"slug":120},6,"Technology",50,"technology",{"id":86,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":122,"slug":123},40,"healthcare",{"id":125,"doc_module":4,"doc_module_name":25,"category_name":126,"show_sort_weight":127,"slug":128},8,"Research & Report",30,"research-report",{"id":130,"doc_module":4,"doc_module_name":25,"category_name":131,"show_sort_weight":132,"slug":133},9,"Religion & Spirituality",20,"religion-spirituality",{"id":132,"doc_module":4,"doc_module_name":25,"category_name":135,"show_sort_weight":132,"slug":136},"World Cup","world-cup",{"id":55,"doc_module":4,"doc_module_name":25,"category_name":138,"show_sort_weight":55,"slug":139},"Lifestyle","lifestyle",{"id":141,"doc_module":4,"doc_module_name":25,"category_name":142,"show_sort_weight":112,"slug":143},19,"General","general"]