A 36-year-old male underwent a cervical nucleoplasty procedure at the C3/C4 level for chronic neck pain. During the procedure, the introducer cannula was advanced past the nucleus against recommendations. Upon withdrawal of the damaged SpineWand, a fragment was discovered left behind in the annulus. A post-procedure CT scan showed the fragment in the left side of the annulus. The patient now complains of new severe left-sided axial pain upon rotation, suggesting the fragment may be a source of new pain.

1. Fragment of SpineWand left during cervical nucleoplasty procedure
Michael Clark, 30 Mar 2008
A C3/C4 Nucleoplasty procedure was performed on a 36yr old male with an 8yr history of chronic
cervicogenic headache. The patient suffers from a dull neuralgia like bilateral pain of VAS4 intensity in the
sub-occipital region, chronic hypertonicity of the upper trapezius muscle, and inner ear pain during periods
when the condition is aggravated.
Prior MRI imaging was not conclusive although a mild disc bulge was observed at the C3/C4 level in
addition to uncovertebral osteophyte formation resulting in a borderline mild exit foraminal stenosis on the
left 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 irritation
causing the patient to cough during the procedure. It was decided to perform a nucleoplasty under GA with a
right anterolateral approach.
During the procedure, the introducer cannula was advanced past the centre of the nucleus (against the
recommendations in the DC SpineWand Technique Guide). It was noticed after the initial retraction that a
fragment was left behind. At this point, the damaged SpineWand was withdrawn and the procedure continued
with a new SpineWand.
Directly after the procedure the patient complains of pain on the left side. Post procedure CT scan performed
the next day shows the SpineWand fragment in the left side of the annulus. It is assumed that the instrument
broke 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 extending
from 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