Transforaminal retrieval of intradiscal retained broken surgical knife blade.

STUDY DESIGN

Case report.

OBJECTIVE

To report a middle-aged female in whom a knife blade was broken and lodged in the disc space during lumbar discectomy. Transforaminal route as an alternative corridor for its removal is proposed.

SUMMARY OF BACKGROUND DATA

Lumbar discectomy is being done in increasing frequency worldwide. One risk associated with this procedure is breaking of the surgical knife during discectomy. Most of the broken blades can be removed during the initial surgery. However, in a few cases, surgeon's attempts might be unsuccessful, resulting in retained foreign body in the disc space. Literature regarding this issue is scarce, and there are no unique guidelines to address this complication.

METHODS

A 69-year-old female in whom a surgical knife blade was inadvertently broken and retained in the disc space during lumbar discectomy. The broken blade could not be removed during the first surgery. In the second surgery, it was retrieved through the initial midline incision but via transforaminal route.

RESULTS

The patient was discharged a day after blade removal and is doing well now.

CONCLUSION

Retrieval of a broken knife blade unintentionally buried in the intervertebral disc space can be a challenge and even impossible to achieve, despite hours of attempts. In the second surgery, the retained blade in the disc space is traditionally removed via the anterior approach. The transforaminal corridor might be a simple alternative route that does not carry inherent difficulties and risks associated with the anterior corridor. Eventually, removal of a broken blade via this route does not require the collaboration of an access surgeon.