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Rescue technique for trapped bone needle in cement cast
  1. Alexandru Dimancea1,2,
  2. Kevin Premat3,
  3. Eimad Shotar4,
  4. Evelyne Cormier3,
  5. Pierre-Marie Chiaroni5,
  6. Jugurtha Mahtout6,
  7. Frédéric Clarençon7,8
  1. 1Neuroradiology, Hopital Universitaire Pitie Salpetriere, Paris, France
  2. 2Neurology, Bucharest Emergency University Hospital, Bucharest, Romania
  3. 3Interventional Neuroradiology, Groupe hospitalier Pitié Salêtrière, Paris, France
  4. 4Neuroradiology, Pitié-Salpêtrière Hospital, APHP, Paris, France
  5. 5Department of Neuroradiology, University Hospital Pitié Salpêtrière, Paris, France
  6. 6Anesthésie-Réanimation, Hopital Universitaire Pitie Salpetriere, Paris, France
  7. 7Sorbonne Université, Paris, France
  8. 8Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
  1. Correspondence to Dr Alexandru Dimancea, Neuroradiology, Hopital Universitaire Pitie Salpetriere, 75013 Paris, France; alexandruandreidimancea{at}gmail.com

Abstract

Avascular necrosis, or Kummel disease, is a potential complication of vertebral compression fractures. It is believed to arise as a result of a failed fracture healing process,1 2 leading to the formation of an air or fluid filled cavity within the vertebral body.3 Percutaneous vertebroplasty seems to provide both pain relief and increased spinal stability in avascular necrosis.4 In this technical video, we present the case of an osteoporotic patient with a complicated vertebroplasty, caused by trapping of the bone needle inside the intravertebral cement cast. Two methods were used sequentially, leading to retrieval of the bone needle. We identified several technical aspects, such as injection speed, quasi-filling of the vertebral cavity, and frequent rotation of the bone needle as essential for the success of the procedural. We suggest that improving these parameters may prevent intravertebral bone needle trapping in patients with avascular necrosis.

Video 1

  • Lumbosacral
  • MRI
  • Spine
  • Technique

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Footnotes

  • Contributors AD, KP, and FC: manuscript redaction and video preparation. ES and EC: video preparation. P-MC and JM: critical review of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests FC reports conflicts of interest with Medtronic, Guerbet, Balt Extrusion, Penumbra (payment for readings; not related to the study), Codman Neurovascular, and Microvention (core lab; not related to the study).

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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