Department of Spine Surgery, Taizhou Hospial of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang, China.
Department of Spine Surgery, Taizhou Hospial of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang, China.
World Neurosurg. 2020 May;137:272-275. doi: 10.1016/j.wneu.2020.01.221. Epub 2020 Feb 5.
Surgical scalpel broken is rarely reported in posterior lumbar discectomy or fusion surgeries, but when it happens and even the broken part is deeply located in the disk space, there is no guideline to remove it during the initial surgery.
A 56-year-old female with L3-L4 and L4-L5 disk herniation and stenosis underwent 2-level transforaminal lumbar diskectomy and fusion. The knife blade was broken in the L4-L5 disk space during the annulus resection. Despite a 1.5-hour trial for removal with fluoroscopy, the broken part gradually migrated to the anterior border of the disk space. Eventually, arthroscopy was used for retrieval, the blade tip was clearly recognized in the arthroscopic view, which improved the accuracy of the subsequent operation. The blade fragment was removed successfully within 30 minutes.
Arthroscopic retrieval of a broken scalpel deeply located in the intradiskal space is recommended as an alternative method when conventional effort is unable to remove it, especially when the broken blade migrates anteriorly, which may provoke catastrophic consequences.
后路腰椎间盘切除或融合术中手术刀折断很少见，但当这种情况发生且折断部分甚至深置于椎间盘间隙时，在初次手术中没有指导原则来取出折断部分。
一名 56 岁女性，患有 L3-L4 和 L4-L5 椎间盘突出症和狭窄，行 2 节段经椎间孔腰椎间盘切除术和融合术。在环锯切除过程中，刀头在 L4-L5 椎间盘间隙折断。尽管使用透视进行了 1.5 小时的尝试，但折断部分逐渐向椎间盘间隙的前缘迁移。最终，使用关节镜进行了检索，在关节镜视图中清楚地识别出了刀尖，这提高了后续手术的准确性。30 分钟内成功取出了刀片碎片。
当常规方法无法取出时，建议使用关节镜检索法来替代，尤其是当折断刀片向前迁移时，可能会引发灾难性后果。
