Rescue cement augmentation for a one-level corpectomy cage after malposition: a case report of salvage following graft-endplate noncontact and cage migration

Cage malposition following lumbar corpectomy is a rare complication, particularly when the interbody cage fails to make contact with the adjacent vertebral endplates. This “floating cage” scenario can lead to serious consequences, including screw loosening, cage migration, and neurological symptoms. However, standardized management strategies for this complication have not been well established. We report the case of a 70-year-old man with osteoporosis who developed severe radicular pain and thoracolumbar kyphosis one month after undergoing L1 corpectomy with expandable cage placement and posterior screw fixation from T12 to L2. Imaging revealed cage migration into the right L2 body with screw displacement, resulting from initial noncontact between the cage and the inferior endplate. The patient was successfully treated using rescue vertebroplasty to stabilize the cage, along with additional screw fixation at L3–L4 and cement augmentation. This case demonstrates that rescue vertebroplasty can serve as a minimally invasive and effective alternative to full cage revision in the management of floating cage complications. Early detection and timely intervention are crucial, particularly in patients with poor bone quality. As the use of expandable cages continues to increase in spinal surgery, greater awareness of this complication is essential.