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Case report
Republished: Retained needle after cement injection during vertebral augmentation and its management strategy
  1. Angelika Kosse1,
  2. Jonathan Pishoi Nakhla2,
  3. Reza Yassari3,
  4. Apolonia Elisabeth Abramowicz4,
  5. Allan Brook5
  1. 1Department of Anesthesiology, Montefiore Medical Center, Bronx, New York, USA
  2. 2Department of Neurological Surgery, Montefiore Medical Center, Bronx, New York, USA
  3. 3Department of Neurosurgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
  4. 4Bronx, USA
  5. 5Montefiore Medical Center, Bronx, New York, USA
  1. Correspondence to Dr J P Nakhla, Department of Neurological Surgery, Montefiore Medical Center, Bronx, NY 10467, USA; jonathan.nakhla{at}


A middle aged patient with multiple myeloma resulting in numerous pathological fractures underwent an L2, L3, and L5 vertebral cement augmentation for pain relief. After injection, the trocar at L2, the final level, could not be withdrawn despite several attempts of needle rotation, a second needle inserted to distract on, and rocking the needle on the pedicle. After a neurosurgical consultation, the patient was transferred to the operating room for open removal. As the needle protruded approximately 3 inches from the patient's back, the patient could not be positioned supine, and was anesthetized and intubated in the right semi-prone position prior to being placed prone on the operating room table. The needle was surgically exposed, cut off at the pedicular bone edge, and its free component was removed.

  • Complication
  • Degenerative
  • Intervention
  • Lumbosacral
  • Technique

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  • Republished with permission from BMJ Case Reports Published 18 February 2016; doi:10.1136/bcr-2015-012180

  • Twitter Follow Jonathan Nakhla at @jonnynak

  • Contributors All authors participated in the creation, editing, and drafting of this case report.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.