Shah Neal A, Catlin Eric, Jassal Navdeep, Hafez Osama, Padalia Devang
Anesthesia and Interventional Pain Management, H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA.
Physical Medicine and Rehabilitation, University of South Florida, Tampa, USA.
Cureus. 2019 Apr 2;11(4):e4367. doi: 10.7759/cureus.4367.
To date, no case studies specifically describing a curved kyphoplasty needle becoming lodged in the vertebral body with the inability to be withdrawn have been reported. We describe a case involving a single level balloon kyphoplasty with a curved coaxial needle during which the cement delivery device could not be removed after cavity filling. In this case, a board-certified interventional pain management specialist was performing balloon kyphoplasty for an L2 osteoporotic vertebral compression fracture. The tools utilized in this procedure included flexible curved instruments designed to traverse the vertebral body and achieve uniform cement distribution through a unipedicular approach. Cannulation and cavity formation were completed without issue. Upon conclusion of cement filling, the curved cement delivery device was unable to be removed. After several attempts to remove the needle and consultation with both the device company and local spine surgeons, it was agreed that the device should be cut at the level of entry into the pedicle and left as a retained foreign object. The involved area was surgically exposed, the retained instrument was cut flush to the pedicle, and the free portion was removed without further complication. The patient followed up in clinic several months later without evidence of neurologic complications. Considerations when using a curved kyphoplasty device and a method of resolution when faced with the inability to remove such an instrument are discussed.
迄今为止，尚未有专门描述弯曲的椎体后凸成形术针滞留在椎体中且无法拔出的病例研究报告。我们描述了一例使用弯曲同轴针进行单节段球囊椎体后凸成形术的病例，在此过程中，在骨水泥注入腔隙后输送装置无法取出。在该病例中，一位获得委员会认证的介入疼痛管理专家正在为一名L2骨质疏松性椎体压缩骨折患者进行球囊椎体后凸成形术。该手术中使用的工具包括设计用于穿过椎体并通过单椎弓根入路实现骨水泥均匀分布的柔性弯曲器械。置管和腔隙形成过程顺利完成。在骨水泥注入结束后，弯曲的骨水泥输送装置无法取出。在多次尝试取出针并与器械公司和当地脊柱外科医生协商后，一致认为应在进入椎弓根的水平处切断该装置，并将其作为异物留存。手术暴露相关区域，将留存的器械与椎弓根齐平切断，取出游离部分，未出现进一步并发症。数月后患者在门诊随访，未发现神经并发症迹象。本文讨论了使用弯曲椎体后凸成形术器械时的注意事项以及面对此类器械无法取出时的解决方法。
