Retained needle after cement injection during vertebral augmentation and its management strategy

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Interventional Radiology

Background:

• Vertebral augmentation is a common procedure for managing pathological fractures in patients with multiple myeloma.
• Pain relief is a primary goal, often achieved through cement injection into fractured vertebrae.
• Complications, though rare, can impact procedural success and patient safety.

Observation:

• A retained trocar at the L2 level occurred after vertebral cement augmentation.
• Multiple attempts to remove the trocar, including needle rotation and distraction, were unsuccessful.
• The trocar remained lodged in the pedicle, necessitating surgical intervention.

Findings:

• Open surgical removal of the impacted L2 trocar was performed.
• The patient required specialized anesthesia and positioning (semi-prone then prone) due to the trocar's protrusion.
• The trocar was surgically exposed, transected at the bone edge, and the protruding component removed.

Implications:

• This case highlights a rare but significant complication of vertebral augmentation.
• It underscores the importance of careful technique and preparedness for potential procedural challenges.
• Management requires a multidisciplinary approach involving interventional radiology and neurosurgery for safe resolution.