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Case Reports
, 10 (1), 277

Surgical Treatment of a Broken Neuroplasty Catheter in the Epidural Space: A Case Report

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Case Reports

Surgical Treatment of a Broken Neuroplasty Catheter in the Epidural Space: A Case Report

Tae Hyun Kim et al. J Med Case Rep.

Abstract

Background: Percutaneous epidural neuroplasty with a Racz catheter is widely used to treat radicular pain caused by spinal stenosis or a herniated intervertebral disc. The breakage or shearing of an epidural catheter, particularly a percutaneous epidural neuroplasty catheter, is reported as a rare complication. There has been a controversy over whether surgical removal of a shorn epidural catheter is needed. Until now, only three cases related to sheared Racz neuroplasty catheters have been reported. We report a case of a neuroplasty catheter which completely broke when it was inserted into the epidural space, and compressed root symptoms were exacerbated by the broken catheter.

Case presentation: A 68-year-old Asian man with leg pain and lower back pain caused by lumbar vertebral body 4 to lumbar vertebral body 5 intervertebral disc herniation and stenosis underwent percutaneous epidural neuroplasty. During the procedure, the epidural neuroplasty catheter was trapped in the left foraminal portion and broke. Our patient complained of left-side leg pain and numbness. Surgery performed to remove the broken catheter led to complete resolution of his leg pain and numbness.

Conclusions: We report a rare case of catheter breakage occurring during epidural neuroplasty. We suggest surgical removal because the implanted catheter can aggravate a patient's symptoms and lead to the development of neurologic deficits due to infection, fibrosis, or mechanical neural irritation.

Keywords: Catheter breakage; Complications; Epidural catheter; Intervertebral disc herniation; Lower back pain; Lumbar spine; Neuroplasty; Surgery.

Figures

Fig. 1
Fig. 1
Preoperative radiographs and lumbar magnetic resonance imaging. a Dynamic plain radiographs showing degenerative spondylolisthesis of lumbar vertebral body 4 on lumbar vertebral body 5. The radiographic finding showed anterior slipping of lumbar vertebral body 4 on lumbar vertebral body 5 when the patient bent his back (arrow). An extension view shows the slight reduction of anterior slippage of lumbar vertebral body 4 on lumbar vertebral body 5 (arrow). b Sagittal view showing disc protrusion and stenosis of both foramen on lumbar vertebral body 4 and lumbar vertebral body 5. The dural sac was compressed ventrally and dorsally at lumbar vertebral body 4 and lumbar vertebral body 5 on a sagittal view of T2-weighted images. c Axial view showing disc protrusion, stenosis, and facet hypertrophy on lumbar vertebral body 4 and lumbar vertebral body 5. Narrowing of the spinal canal was found with both disc protrusion and ligamentum flavum hypertrophy
Fig. 2
Fig. 2
Lumbar spine three-dimensional computed tomography before catheter fragment removal. a Computed tomography axial view showing the compression of the left lumbar vertebral body 5 nerve root by a broken catheter tip (arrow). b Computed tomography coronal view showing that the catheter fragment tip is located at the left side of the lumbar vertebral body 5/sacral vertebral body 1 foraminal zone (arrow). c Computed tomography sagittal view showing the catheter fragment tip which spans from the sacral hiatus to the lumbar vertebral body 5/sacral vertebral body 1 level (arrow)
Fig. 3
Fig. 3
The epidural neuroplasty catheter. The broken epidural neuroplasty catheter was surgically removed. The proximal tip of the catheter was bent, but the tip sheath was not torn (arrow). The distal portion of the catheter was shorn, but there was no knotting or looping

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References

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