Removal of the Deeply Located Intradiskal Broken Knife Blade with Arthroscopic Assistance: Case Report and Literature Review.

Abstract

Surgical scalpel broken is rarely reported in posterior lumbar discectomy or fusion surgeries, but when it happens and even the broken part is deeply located in the disk space, there is no guideline to remove it during the initial surgery. A 56-year-old female with L3-L4 and L4-L5 disk herniation and stenosis underwent 2-level transforaminal lumbar diskectomy and fusion. The knife blade was broken in the L4-L5 disk space during the annulus resection. Despite a 1.5-hour trial for removal with fluoroscopy, the broken part gradually migrated to the anterior border of the disk space. Eventually, arthroscopy was used for retrieval, the blade tip was clearly recognized in the arthroscopic view, which improved the accuracy of the subsequent operation. The blade fragment was removed successfully within 30 minutes. Arthroscopic retrieval of a broken scalpel deeply located in the intradiskal space is recommended as an alternative method when conventional effort is unable to remove it, especially when the broken blade migrates anteriorly, which may provoke catastrophic consequences.