1318 - Needle Malfunction During Cervical Medial Branch Block: A Case Report and Safety Response

Case Diagnosis: Cervical Spondylosis Without Myelopathy or Radiculopathy, Bilateral

Case Description: A 72-year-old woman underwent fluoroscopy-guided medial branch blocks at C3, C4, and C7
bilaterally. During unsheathing of the final 25G spinal needle at the right C4 site, only the plastic hub
detached without the inner stylet, raising concern for a retained foreign body. The needle was removed
immediately. Fluoroscopic and radiographic imaging, along with comparison to a reference filament,
revealed no retained material.

Discussions: Device-related complications during interventional spine procedures are uncommon but potentially
serious. Commonly reported events include bleeding, infection, or neural injury, while needle component
failure is rarely described. In this case, a spinal needle was missing its internal stylet upon unsheathing—
raising immediate concern for a retained fragment.

The team’s prompt recognition and use of intraoperative imaging—combined with a reference filament—
allowed for a confident exclusion of retained material. Communication with a consulting radiologist
helped to support real-time clinical decision-making.

Ultimately, a retained foreign body was ruled out, and unnecessary advanced imaging or surgical
exploration was avoided.

This case underscores the need for continued vigilance regarding equipment function and highlights the
importance of procedural readiness, interdisciplinary communication, and real-time problem-solving in
procedural settings. Institutional reporting and manufacturer notification of defective supplies are essential
steps in promoting device safety.

Conclusions: This case illustrates a rare instance of needle malfunction in a routine cervical medial branch block. Rapid
intraoperative investigation and imaging, supported by team-based collaboration, ensured safe resolution
and patient reassurance. Clinicians should remain alert to potential equipment issues and report such
occurrences to promote quality improvement and patient safety.