Corr Felix, Almealawy Yasser F, Heinig Silvio, Bättig Linda, Schulz Erik, Hejrati Nader, Bertulli Lorenzo, Heisinger Stephan, Bozinov Oliver, Stienen Martin N, Motov Stefan
Department of Neurosurgery & Interdisciplinary Spine Center, HOCH Health Ostschweiz, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007 St. Gallen, Switzerland.
Faculty of Medicine, University of Kufa, Kufa P.O. Box 21, Iraq.
J Clin Med. 2025 Jun 16;14(12):4265. doi: 10.3390/jcm14124265.
Retained epidural catheter fragments are an infrequent but clinically relevant complication of neuraxial anesthesia. Optimal management remains undefined, with limited evidence guiding treatment selection or risk stratification. This systematic review synthesized individual patient data to compare treatment strategies, examine surgical outcomes, and determine predictors of intervention. A systematic review was conducted across six databases in accordance with PRISMA guidelines (PROSPERO: CRD420025638305). Adult cases of retained epidural catheter fragments were included. Functional outcomes were standardized using modified MacNab, McCormick, and Therapy-Disability-Neurology (TDN) scores. Predictors of surgery and detectability were assessed using univariate and multivariate logistic regression models with Firth correction. Forty studies comprising 51 patients were included. Conservative management was chosen in 23 cases (45%); 39.1% ( = 9) ultimately required delayed surgery due to symptom onset during follow-up. Surgical removal ( = 28, 55%) was safe and yielded excellent outcomes in 95.8% of cases. Fragment length was significantly associated with increased odds of surgery (OR = 1.05, 95% CI: 1.01-1.10, = 0.04), while catheter material was associated with surgery in univariate analysis (OR = 2.49, 95% CI: 1.08-9.00, = 0.03). An MRI demonstrated the highest diagnostic accuracy (AUC = 0.859, cutoff = 70 mm catheter length), outperforming CT (AUC = 0.611) and X-ray (AUC = 0.533). Across all patients, 84.3% achieved "Excellent" recovery per MacNab, with no neurological deterioration in any surgical case. Surgical removal of retained epidural catheter fragments is safe and effective in symptomatic patients. Conservative management is viable for asymptomatic cases under structured surveillance. Catheter material and fragment length may dictate imaging selection and treatment decisions.
硬膜外导管碎片残留是一种少见但具有临床相关性的神经轴索麻醉并发症。最佳治疗方案尚不明确，指导治疗选择或风险分层的证据有限。本系统评价综合个体患者数据以比较治疗策略、检查手术结果并确定干预的预测因素。根据PRISMA指南（国际前瞻性系统评价注册平台：CRD420025638305）在六个数据库中进行了系统评价。纳入成年硬膜外导管碎片残留病例。使用改良的MacNab、McCormick和治疗-残疾-神经病学（TDN）评分对功能结局进行标准化。使用带有Firth校正的单因素和多因素逻辑回归模型评估手术和可检测性的预测因素。纳入了40项研究，共51例患者。23例（45%）选择保守治疗；39.1%（n = 9）因随访期间出现症状最终需要延迟手术。手术取出（n = 28，55%）是安全的，95.8%的病例取得了良好的结果。碎片长度与手术几率增加显著相关（比值比[OR]=1.05，95%置信区间[CI]：1.01-1.10，P = 0.04），而导管材料在单因素分析中与手术相关（OR = 2.49，95% CI：1.08-9.00，P = 0.03）。磁共振成像（MRI）显示出最高的诊断准确性（曲线下面积[AUC]=0.859，临界值=导管长度70 mm），优于计算机断层扫描（CT）（AUC = 0.611）和X线（AUC = 0.533）。在所有患者中，根据MacNab标准，84.3%实现了“优秀”恢复，任何手术病例均未出现神经功能恶化。对于有症状的患者，手术取出残留的硬膜外导管碎片是安全有效的。在有组织的监测下，无症状病例采用保守治疗是可行的。导管材料和碎片长度可能决定影像学选择和治疗决策。
