Authors: Correia P et al.
Cureus 17(11): e96826 DOI: 10.7759/cureus.96826
Summary
This case report describes a term parturient with obesity and scoliosis who experienced a spinal needle fracture during attempted spinal anesthesia for a cesarean section. After failed labor epidural analgesia and inadequate block quality from the epidural catheter, spinal anesthesia was attempted using a 27G Whitacre needle with introducer. Multiple attempts were required before cerebrospinal fluid was obtained, and the anesthesiologist delivered only a small intrathecal dose due to slow CSF flow. When attempting to withdraw the needle, unexpected resistance occurred and the needle snapped, leaving a 4-cm fragment in the paravertebral musculature.
General anesthesia was initiated, the cesarean delivery proceeded without complications, and the patient remained entirely asymptomatic postoperatively. CT imaging confirmed the retained fragment outside the spinal canal. On postpartum day three, the fragment was removed endoscopically with no sequelae. Follow-up was uneventful.
The report highlights classic risk factors for this complication—obesity, scoliosis, difficult anatomy, and repeated needle attempts. It underscores the importance of imaging for localization, individualized decision-making regarding fragment removal, and prevention through minimizing attempts, avoiding excessive force, maintaining needle–introducer alignment, and considering neuraxial ultrasound in challenging anatomy.
What You Should Know
• Spinal needle fracture is extremely rare but most often associated with difficult anatomy and multiple attempts.
• Scoliosis and obesity significantly increase mechanical stress during neuraxial procedures.
• CT is the preferred imaging modality to locate retained spinal fragments.
• Endoscopic removal is safe and effective when the fragment is superficial and accessible.
• Neuraxial ultrasound may reduce puncture attempts and mechanical complications in high-risk obstetric patients.
• Careful technique and proper equipment handling remain key preventive strategies.
References
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