Patient selection is a critical step prior to balloon kyphoplasty. While foraminal stenosis adjacent to the target vertebra is not necessarily a contraindication, this case exemplifies how a common complication such as cement leakage can have detrimental effects when there are anatomic abnormalities in the near vicinity. Various strategies to minimize extravasation can be employed, including slow, low-volume, and low-pressure injection, using higher viscosity cement, and employing the "eggshell" technique2. Once extravasation is suspected, injection should be stopped immediately and confirmed with diagnostic imaging. Neurosurgical consultation is also warranted to assess candidacy for surgical intervention. Our management provides rationale for the use of transforaminal steroid injection to control symptoms after such an extravasation occurs.