Retained needle after cement injection during vertebral augmentation and its management strategy.

A middle aged patient with multiple myeloma resulting in numerous pathological fractures underwent an L2, L3, and L5 vertebral cement augmentation for pain relief. After injection, the trocar at L2, the final level, could not be withdrawn despite several attempts of needle rotation, a second needle inserted to distract on, and rocking the needle on the pedicle. After a neurosurgical consultation, the patient was transferred to the operating room for open removal.

Retained needle after cement injection during vertebral augmentation and its management strategy.

A middle aged patient with multiple myeloma resulting in numerous pathological fractures underwent an L2, L3, and L5 vertebral cement augmentation for pain relief. After injection, the trocar at L2, the final level, could not be withdrawn despite several attempts of needle rotation, a second needle inserted to distract on, and rocking the needle on the pedicle. After a neurosurgical consultation, the patient was transferred to the operating room for open removal.

O-arm failure traps patient prone on a Jackson table.

The O-arm Surgical Imaging System (Medtronic Sofamor Danek, Memphis, TN, USA) is an increasingly popular tool for spinal surgical procedures that allows for intraoperative acquisition of multi-dimensional spinal imaging that can be used either to confirm placement of spinal instrumentation or to guide spinal screw placement in conjunction with a navigation system. The machine is typically placed open from the side of the patient positioned prone on the Jackson spinal table (Mizuho OSI, Union City, CA, USA) and then closed to complete a ring around the patient to acquire images. A failure of the O-arm opening mechanism can lead to a patient becoming effectively trapped within the device with limited physician access to the patient's body, a situation that may be remedied by using a manual opening procedure.

Elevated pulmonary artery systolic storage volume associated with improved ventilation-to-perfusion ratios in acute respiratory failure.

The possibility that an elevated pulmonary artery systolic storage volume (PASSV) correlates with improved overall ratios of ventilation-to-perfusion and hence benefits gas exchange in acute respiratory failure was examined. We examined this by assessing the correlation between PASSV and both the physiologic dead space to tidal volume ratio (VD/VT) and intrapulmonary shunt fraction (Qsp/Qt). The VD/VT and Qsp/Qt were used as an index of distribution of ventilation-to-perfusion as well as efficiency of pulmonary gas exchange.