Čeleš Dejan, Gasparini Mladen, Mohar Janez
Department of Spine Surgery, Valdoltra Orthopaedic Hospital, Ankaran, Slovenia.
Department of Surgery, General Hospital Izola, Izola, Slovenia.
Front Surg. 2023 Sep 27;10:1266102. doi: 10.3389/fsurg.2023.1266102. eCollection 2023.
The presence of broken surgical blades or other surgically uncontrolled sharp and pointed objects in the disc space is a rare but potentially severe complication of posterior lumbar spine procedures. Herein, we report the case of a 59-year-old female patient with a history of lumbar decompression and interspinous process device implantation who underwent an instrumented revision of the lumbosacral junction. During the L5-S1 discectomy, the scalpel blade broke, and the broken fragment could not be retrieved through the posterior approach. With regard to the vascular anatomy, we partially pushed the fragment through the anterior annulus into the retroperitoneal space. In addition, pedicle screws were locked to ensure the stability of the construct. The fractured blade fragment was eventually removed by laparoscopy 1 week after the initial procedure. This experience suggests that the anterior pushing technique with fluoroscopy is an option in rare cases where a broken scalpel blade cannot be reached through the posterior approach. In such cases, computed tomography angiography is recommended.
椎间盘间隙中出现折断的手术刀片或其他手术中无法控制的尖锐物品是腰椎后路手术罕见但可能严重的并发症。在此，我们报告一例59岁女性患者，有腰椎减压和棘突间装置植入史，接受了腰骶部节段的器械翻修手术。在L5-S1椎间盘切除术中，手术刀刀片折断，折断的碎片无法通过后路取出。考虑到血管解剖结构，我们将碎片部分从前侧纤维环推入腹膜后间隙。此外，椎弓根螺钉被锁定以确保结构的稳定性。最初手术后1周，最终通过腹腔镜取出了折断的刀片碎片。这一经验表明，在罕见的无法通过后路取出折断手术刀刀片的情况下，透视下前推技术是一种选择。在这种情况下，建议进行计算机断层血管造影。
