Retained Curved Needle After Balloon Kyphoplasty: A Complication with a Novel Device and Its Management

Abstract

To date, no case studies specifically describing a curved kyphoplasty needle becoming lodged in the vertebral body with the inability to be withdrawn have been reported. We describe a case involving a single level balloon kyphoplasty with a curved coaxial needle during which the cement delivery device could not be removed after cavity filling. In this case, a board-certified interventional pain management specialist was performing balloon kyphoplasty for an L2 osteoporotic vertebral compression fracture. The tools utilized in this procedure included flexible curved instruments designed to traverse the vertebral body and achieve uniform cement distribution through a unipedicular approach. Cannulation and cavity formation were completed without issue. Upon conclusion of cement filling, the curved cement delivery device was unable to be removed. After several attempts to remove the needle and consultation with both the device company and local spine surgeons, it was agreed that the device should be cut at the level of entry into the pedicle and left as a retained foreign object. The involved area was surgically exposed, the retained instrument was cut flush to the pedicle, and the free portion was removed without further complication. The patient followed up in clinic several months later without evidence of neurologic complications. Considerations when using a curved kyphoplasty device and a method of resolution when faced with the inability to remove such an instrument are discussed.

Should kyphoplasty curettes be used in nonosteoporotic patients? A cautionary tale

“…This relative lack of information on the failure stress of such relatively new instruments in the rapidly progressing field of kyphoplasty techniques (and the concomitant need of further biomechanical studies on the mechanical properties of such devices) is further corroborated by a similar recent report of an unretrievable curved kyphoplasty needle …”

A Smart Technique to Remove Ruptured Inflatable Bone Tamp From the Vertebral Body in Balloon Kyphoplasty

“…They followed the patient 12 months postoperatively, but no neurologic complications or complaints were reported. In contrast with Chalhoub et al [3] and Shah et al [9] who decided to retain bone tamp and needle respectively inside the lumbar vertebral body, we removed the completely broken and deflated bone tamp, because we were skeptic that this foreign object might act as source for a future spinal infection in this elderly woman. Spinal infection is a potential lifethreatening situation, which requires a major surgery, prolonged hospitalization and increased health costs.…”

“…Shah et al present a case of BK for osteoporotic lumbar fracture in an 82-year-old female patient, that was performed via a curved coaxial needle and balloon system [ 9 ]. In this case, the curved needle became lodged in the vertebral body and was impossible to be removed.…”

Vertebroplasty of C2 Pathologic Fracture: A Unique Case Report Using a Curved-Needle Technique

“…A recent case report from Shah et al. does highlight a retained curved needle after a balloon kyphoplasty, demonstrating a potential complication of curved needles: the shape of the needle may predispose to greater difficulty in removal [ 20 ].…”