Removal of a migrated acupuncture needle from the cervical spinal canal with removal confirmation by cone-beam computed tomography in a hybrid operating room

Abstract

Background: Acupuncture has become one of the most popular alternative medical treatments in the world. However, if the needle is inserted incorrectly into the body, various adverse events can occur and, in such cases, the needle should be removed. Acupuncture needles are very thin and fragile, making them difficult to detect and to confirm breakage or residual needle fragments during surgery. We report a case of a patient's self-placed acupuncture needle migrating into the cervical spinal canal and its surgical removal. We used cone-beam computed tomography in the hybrid operating room to confirm that the needle was removed in its entirety.

Case presentation: A 37-year-old man presented with neck pain and gait disturbance.While he was self-acupuncturing, an acupuncture needle accidentally broke, and the remaining part of the needle penetrated and made contact with the cervical spinal cord. Cervical spine radiographs showed a metallic foreign body between the C1 and C2 spinous processes in the direction of the anterior cervical spine. Computed tomography images revealed that the acupuncture needle was penetrating the spinal canal and was in contact with the cervical cord. The acupuncture needle was removed under general anesthesia. The use of cone-beam computed tomography in the hybrid operating room allowed intraoperative confirmation that there was no breakage during needle removal, and no needle fragments were left behind. His symptoms disappeared without any complications after the operation.

Conclusion: To the best of our knowledge, this is the first report of the removal of an acupuncture needle that migrated into the cervical spinal canal using cone-beam computed tomography in a hybrid operating room. Intraoperative cone-beam computed tomography is useful in patients with small, fragile foreign bodies for confirmation of the location of the object and to check for the presence of residual fragments.

Keywords: Acupuncture; Cervical cord; Cone-beam computed tomography; Foreign body; Hybrid operating room; Spinal canal.

Fig. 1

Lateral cervical spine radiograph showing the barely discernible embedded acupuncture needle (white arrow).

Fig. 2

Three-dimensional computed tomography (CT) images demonstrate the orientation of the acupuncture needle from between the C1 posterior arch and C2 spinous process to the anterior cervical spine (a, b). Axial CT myelogram shows that the acupuncture needle penetrated the dura mater and was in contact with the cervical spinal cord.

Fig. 3

Intraoperative photograph showing that the acupuncture needle (white arrow) was barely visible between C1 and C2 on the left side (a). Photograph of the removed acupuncture needle (b).

Fig. 4

Cone-beam computed tomography in a hybrid operating room enabled intraoperative confirmation that no broken or residual acupuncture needles remained (left, sagittal view; right, axial view).