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Nucleoplasty complication

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  • 1. Fragment of SpineWand left during cervical nucleoplasty procedureMichael Clark, 30 Mar 2008A C3/C4 Nucleoplasty procedure was performed on a 36yr old male with an 8yr history of chroniccervicogenic headache. The patient suffers from a dull neuralgia like bilateral pain of VAS4 intensity in thesub-occipital region, chronic hypertonicity of the upper trapezius muscle, and inner ear pain during periodswhen the condition is aggravated.Prior MRI imaging was not conclusive although a mild disc bulge was observed at the C3/C4 level inaddition to uncovertebral osteophyte formation resulting in a borderline mild exit foraminal stenosis on theleft side. The patient wanted discography to rule out the disc as a source of pain.Discography was not performed because of the high level and the potential risk of laryngeal nerve irritationcausing the patient to cough during the procedure. It was decided to perform a nucleoplasty under GA with aright anterolateral approach.During the procedure, the introducer cannula was advanced past the centre of the nucleus (against therecommendations in the DC SpineWand Technique Guide). It was noticed after the initial retraction that afragment was left behind. At this point, the damaged SpineWand was withdrawn and the procedure continuedwith a new SpineWand.Directly after the procedure the patient complains of pain on the left side. Post procedure CT scan performedthe next day shows the SpineWand fragment in the left side of the annulus. It is assumed that the instrumentbroke upon rotation of the flange while the tip was piercing the relatively harder material of the annulus.Patient now complains of severe left-sided axial pain upon lateral rotation and dull left-sided pain extendingfrom the shoulder to the sub-occipital region. Illustration 1: ArthoCare DC Illustration 3: SpineWand Illustration 4: SpineWand SpineWand Fragment AP view fragment lateral view Illustration 2: Post procedure CT Illustration 5: Post procedure CT axial view oblique view