Endoscopic-Assisted Spinal Approach to Remove a Broken Spinal Needle: Technical Notes and Case Report of a...

Spinal anesthesia is widely used for many surgical procedures in orthopedic surgery. The breakage of a spinal needle within the patient's intrathecal space represents a rare but potentially serious complication. The management of a broken spinal needle (BSN) remains unclear. Only a few clinical cases have been reported, and no surgical guidelines are available in the literature to date. Early surgical removal of the broken needle appears to be advisable.

A 65-year-old woman with a body mass index (BMI) of 32.1 kg/m² was admitted to the operating theater for a knee arthroscopy. During spinal anesthesia, the tip of the needle broke off and remained in the patient's back. The needle had a diameter of 25 gauge, and the retained fragment measured approximately 35 mm in length. Throughout the entire surgical procedure, the patient was maintained in the left lateral decubitus to prevent migration of the needle fragment. Initially, radiological landmarks were obtained with a C-arm to localize the spinal needle. Once identified, a first percutaneous attempt to remove it with a different type of forceps was unsuccessful. Once endoscopic equipment was prepared, two small Farabeuf retractors and a self-retaining retractor (Caspar lumbar retractor system) were positioned, and a 30° arthroscope was inserted by the surgeon. The broken needle was clearly visualized once arthroscopic saline inflow was initiated (inflow pump pressure 50 mmHg): the fluid dilated the muscle fibers and clearly exposed the BSN. The fragment was then successfully removed using arthroscopic grasping forceps, without any risk of mobilization or further breakage.

In cases of a BSN during spinal anesthesia:-early removal should be performed;-the patient should be kept in the same position;-radiological landmarks should be obtained using a C-arm;-if available, an endoscopic-assisted spinal surgical approach should be considered as an effective and safe technique for needle removal.