Broken blade tip in lumbar disc space retrieved via anterior trans-abdominal approach: a rare but potentially devastating complication of lumbar spine surgery.

Bhavuk Garg; Arvind Kumar; Sahil Gaba; Piyush Ranjan

Volume : VIII, Issue : I, January - 2019

Broken blade tip in lumbar disc space retrieved via anterior trans-abdominal approach: a rare but potentially devastating complication of lumbar spine surgery.

Bhavuk Garg, Arvind Kumar, Sahil Gaba, Piyush Ranjan

Abstract :

Purpose: Breaking of scalpel blade inside a disc space during lumbar spine surgery is a seldom reported potentially fatal complication. We report a case of oken number 15 scalpel blade during lumbar transforaminal lumbar inter–body fusion (TLIF) surgery, retrieved via anterior trans–abdominal approach.

Methods: The tip of a number 15 scalpel blade was oken inside the L3–L4 disc space and all efforts to retrieve the oken fragment were in vain. The help of a general surgeon was sought and the fragment was successfully retrieved via transabdominal approach to retroperitoneum. A review of previous such case reports is also presented.

Results: A transabdominal approach was used and retroperitoneum was entered below the level of aortic bifurcation. The sharp fragment was felt just below the left common iliac artery and was grasped out carefully. Patient tolerated the procedure well and the post–operative period was uneventful. Patient was discharged 8 days after surgery and had satisfactory improvement in her back pain and radiculopathy related symptoms.

Conclusion: The anterior transabdominal route provides a potential solution for anteriorly displaced blade fragment during lumbar disc surgery when posterior transforaminal route fails to retrieve it. While entering the disc space with a number 15 blade, one should be careful not to rotate the blade within the disc space and avoid grating against the sclerotic end plate.