Frank Yuk1, Jeremy Steinberger1, Branko Skovrlj1, Justin Mascitelli1, Samuel K Cho2, John M Caridi3. 1. Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA. 2. Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA. 3. Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA. Electronic address: john.caridi@mountsinai.org.
Abstract
BACKGROUND: Spine surgery relies heavily on technology and surgical instrumentation. Improperly used instrumentation can be detrimental to the patient. Despite multiple checkpoints to ensure that foreign bodies are not retained in surgery, numerous case reports have described retained foreign bodies; however, none of these cases involve retained instrumentation after open spine surgery. Of the retained objects, 4 were sponges and one was a Jamshidi needle fragment. Although smaller objects are more commonly the culprits, surgical instruments can break off, remain stuck, and cause clinical sequelae. CASE DESCRIPTION: This case presents a retained fractured pedicle finder as the cause of right L5 radiculopathy. To our knowledge, this report is the first to describe an instrumentation-associated postoperative radiculopathy. Because of the strength with which the object was impacted, its extraction proved difficult. CONCLUSIONS: The technique of removal using a mallet and osteotome in 4 directions to loosen its hold in the vertebral body. Attempts and eventual successful removal are described.
BACKGROUND: Spine surgery relies heavily on technology and surgical instrumentation. Improperly used instrumentation can be detrimental to the patient. Despite multiple checkpoints to ensure that foreign bodies are not retained in surgery, numerous case reports have described retained foreign bodies; however, none of these cases involve retained instrumentation after open spine surgery. Of the retained objects, 4 were sponges and one was a Jamshidi needle fragment. Although smaller objects are more commonly the culprits, surgical instruments can break off, remain stuck, and cause clinical sequelae. CASE DESCRIPTION: This case presents a retained fractured pedicle finder as the cause of right L5 radiculopathy. To our knowledge, this report is the first to describe an instrumentation-associated postoperative radiculopathy. Because of the strength with which the object was impacted, its extraction proved difficult. CONCLUSIONS: The technique of removal using a mallet and osteotome in 4 directions to loosen its hold in the vertebral body. Attempts and eventual successful removal are described.