PMC9530267_01
Male, aged 40, ankylosing spondylitis with kyphosis, preoperative whole spine lateral radiographs showed thoracolumbar kyphosis, spine sagittal imbalance (A), cobb angle 40  (D). The spine sagittal rebalanced (B,C) and the Cobb angle corrected to 20  (E,F), tested 1 month and 6 months after operation, respectively.
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F1
Table 1 shows the sagittal score changes of the spine sagittal compared between the preoperative and postoperative stages according to the radiographs (Figure 1).
PMC9530267_02
The broken rongeur (arrow) was found in the operation (A). The tip was not invisible in the incision (B).
fsurg-09-963021-g002.jpg
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F2
During the decompression, the surgeon noted that the Kerrison rongeur was withdrawn without cutting edge and the tip was not visible within the incision (Figure 2).
Intraoperative x-ray revealed that the broken metal tip (arrow) was located in the right anterior between the fourth and fifth lumbar vertebrae (A). After L2 vertebral body osteotomy, the metal fragment was found to migrate to the heart (B,C). MR imaging showed abnormal internal vertebral venous plexus in the dorsal part of the 5th lumbar vertebral body, on T1W (D), T2W (E), and axial (F) images. MR, magnetic resonance.
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F3
Intraoperative immediate C-arm fluoroscopy manifested that there was a high-density shadow just in the right anterior between the fourth and fifth lumbar vertebrae (Figure 3A). The tip was found in the left thoracic space between the seventh and eighth rib (Figure 3C).
PMC9530267_03
Radiation and dual-source CTA showed that the rongeur tip was in the auricula dextra (A-C). The tip was found in the auricula dextra close to the right atrioventricular groove (D). Image of the extracted rongeur tip (E). CT was used to confirm (F).
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F4
After surgery, the patient was taken for a dual-source computed tomography angiography (CTA), which revealed that the rongeur tip was located in the auricula dextra (Figure 4A). The patient underwent open-heart surgery to remove the foreign body (Figure 4). The rongeur tip, about 1 cm in length (Figure 4), was found in the auricula dextra, close to the right atrioventricular groove and right coronary artery.
PMC9530267_04
Male, aged 40, ankylosing spondylitis with kyphosis, preoperative whole spine lateral radiographs showed thoracolumbar kyphosis, spine sagittal imbalance (A), cobb angle 40  (D). The spine sagittal rebalanced (B,C) and the Cobb angle corrected to 20  (E,F), tested 1 month and 6 months after operation, respectively.
fsurg-09-963021-g001.jpg
PMC9530267_04_fsurg-09-963021-g001.jpg
F1
Table 1 shows the sagittal score changes of the spine sagittal compared between the preoperative and postoperative stages according to the radiographs (Figure 1).