Vol. 15, #3

Embedded Needles In Acupuncture:
Case Report And Review Of The Literature
Kazutoshi Yokogushi, MD

ABSTRACT
Background   Recent studies provide evidence that the incidence of serious adverse events with acupuncture therapy is rare in standard practice; serious complications usually arise only from illicit use or from gross abuse by incompetent practitioners.
Objective   To explain and warn that serious and life-threatening complications may arise through the use of illicit techniques.
Design, Setting, and Patient   Case report of a 50-year-old man with a history of receiving embedded acupuncture needles for back pain. In addition, review of the literature on complications due to use of embedded needles.
Main Outcome Measures Location of embedded needles on spine radiographs and computed tomography; reports of embedded acupuncture needles and complications.
Results   Imaging studies revealed the needles had migrated into the patient's retroperitoneal space and abdominal aorta. He received an L5 nerve root block resulting in successful pain relief. The patient quit working and limited his activities to prevent further migration of the needles. In the English-language literature, complications due to embedded acupuncture needles and their penetration into vital organs are rarely reported, but there are some cases in the Japanese literature.
Conclusion   Serious or fatal complications may occur with incompetent and careless implantation of needles.
KEY WORDS
Acupuncture, Acupuncture Complications, Embedded Needles, Adverse Events

INTRODUCTION
Acupuncture is a conservative, complementary treatment for pain disorders1-4 and other conditions. However, incompetent and careless practice may cause serious complications such as pneumothorax, cardiac tamponade, neurological damage, local and systemic infections, puncture of body cavities and vital organs, burns, and even death.5-11 Embedding needles, a traditional acupuncture method in Eastern countries, was discarded long ago because it is a potentially harmful procedure. This article demonstrates that serious and life-threatening effects may occur through using illicit needling techniques.

CASE REPORT
A 50-year-old man presented with a 1-month history of increasing low back pain and left leg pain. He had a diskectomy for L4-5 lumbar disk herniation 5 years earlier. However, he experienced low back pain several times after surgery and sought treatment at a chiropractic clinic, receiving physiotherapy that included acupuncture 3 years prior. The patient had embedded needle therapy in the lumbosacral area in 3 sessions within a month. He reported no abdominal pain or discomfort following treatment.

Figure 1. Spine radiograph showing embedded needles around the lumbar spine. A: Anteroposterior view; B: lateral view.


Spine radiographs on his 1st visit showed many embedded needles around the lumbar spine (Figure 1). Computed tomography revealed that some of the needles were migrating into the retroperitoneal space, 1 of them into the abdominal aorta (Figure 2). He was referred to a cardiovascular surgeon who determined that the patient would not benefit from an operation to remove the needles. The patient received an L5 nerve root block, which produced pain relief. The patient ceased employment and limited his activities to prevent further migration of the needles. He remains under careful observation.

DISCUSSION
Acupuncture is regarded as a safe therapy if it is performed by competent practitioners who use it properly. In chronic disorders, a variety of subcutaneous implants are recommended to effect long-term stimulation of the reflex points.

An absorbable, sterile material is usually used because of the potential risk of needle migration. When metal needles are completely implanted into the subcutaneous tissue, they must be taped or anchored by a bead or loop at their outer end to prevent migration; otherwise, they easily move deep through the tissues and penetrate internal organs within several months or years. Broken or forgotten needles are also a potential risk if they not recognized.

In this case, metal needles were intentionally embedded and then neglected by an incompetent practitioner. The period between the needles being embedded and the needle penetration into the abdominal cavity was 3 years. It is not certain how and when the needles began to penetrate the aorta. Meanwhile, the patient had neither abdominal discomfort nor disturbance of circulation in the lower extremities. The decision of whether the needles should be removed is not an easy one; the patient would be at other risk even if eligible for surgery to remove the needles.

Figure 2. Computed tomography scan showing needles migrating into the retroperitoneal space (A, B), and a needle penetrating the abdominal aorta (C).


Reports of complications due to embedded needles and their penetration into vital organs are rarely found in the English-language literature,6-10 but some cases are found in the Japanese literature.11-15 Norhaim6 reported complications and adverse effects of acupuncture collected from 14 years (1981-1994) of articles on MEDLINE. He classified 193 cases in 78 reports into 3 categories: mechanical visceral injury, infection, and others. Three cases in 5 reports of embedded needles were included.

Many Japanese cases of adverse events after acupuncture may not be listed in medical databases such as MEDLINE, CISCOM, and others. Yamashita et al11 reported 124 cases in 89 articles, which were retrieved from Japanese medical databases from 1987-1999. Forty-eight events were caused by needle breakage, including 26 cases of intentionally embedded needles, and 16 cases of accidental breakage.

The incidence of complications due to embedded needles appears to be high in Japan. The migration of a needle into the abdominal aorta, such as in the case described above, has been reported only once in the Japanese literature.15 A 77-year-old woman received many embedded needles for back pain and the penetration of a needle into the abdomen was found more than 7 years after the therapy. The patient had an operation to remove the migrated needle with no complications. Although the Japanese Acupuncture and Moxibustion Association officially recommended in 1976 that members not use embedded needles, the high incidence implies that some practitioners do not abide by the recommendation and are ignorant of the results of malpractice.

CONCLUSION
Recent prospective and retrospective studies indicate that the incidence of minor adverse events associated with acupuncture may be considerable, while serious adverse events are rare in standard practice.16-19 Serious complications have been alleged to result primarily from illicit acupuncture application or from gross abuse by incompetent practitioners. All acupuncture practitioners should be reminded that embedding needles, now regarded as malpractice, may burden the patient with further complications and unnecessary surgery.

REFERENCES

  1. Ter Riet G, Kleijnen J, Knipschild P. Acupuncture and chronic pain: a criteria based meta-analysis. J Clin Epidemiol. 1990;43:1191-1199.
  2. Frymoyer JW, ed. The Adult Spine: Principles and Practice. New York, NY: Raven Press; 1991:1567-1580.
  3. Ernst E, White A. Acupuncture for back pain: a meta-analysis of randomized controlled trials. Arch Intern Med. 1998;158:2235-2241.
  4. Carlson CP, Sjolund BH. Acupuncture for chronic low back pain: a randomized placebo-controlled study with long-tem follow-up. Clin J Pain. 2001; 17:296-305.
  5. Roger P. Serious complications of acupuncture or acupuncture abuses? Am J Acupuncture. 1981;9:347-351.
  6. Norhaim AJ. Adverse effects of acupuncture: a study of the literature for the years 1981-1994. J Altern Complement Med. 1996;2:291-297.
  7. Ernst E, White A. Life-threatening adverse reactions after acupuncture? a systemic review. Pain. 1997;71:123-126.
  8. Peuker ET, White A, Ernst E, Pera F, Filler TJ. Traumatic complications of acupuncture: therapists need to know human anatomy. Arch Fam Med. 1999;8:553-558.
  9. MacPherson H. Fatal and adverse events from acupuncture: allegation, evidence, and the implications. J Altern Complement Med. 1999;5:47-56.
  10. Puker ET, Gronemeyer D. Rare but serious complications of acupuncture: traumatic lesions. Acupuncture. 2001;19:103-108.
  11. Yamashita H, Tsukayama H, White AR, Tanno Y, Sugishita C, Ernst E. Systematic review of adverse events following acupuncture: the Japanese literature. Complement Ther Med. 2001;9:98-104.
  12. Shiraishi S, Goto I, Kuroiwa Y, Nishio S, Kinoshita K. Spinal cord injury as a complication of acupuncture. Neurology. 1979;29:1188-1190.
  13. Yuzawa M, Hara Y, Kobayashi Y, et al. Foreign body stone of the urethra as a complication of acupuncture: report of a case [in Japanese]. Hinyokika Kiyo. 1991;37:1323-1327.
  14. Matsui S, Matsuoka K, Nakagawa K, Kohno K, Sakaki S. Cervical spinal cord injury caused by a broken acupuncture needle: a case report [in Japanese]. No Shinkei Geka. 1992;20:499-503.
  15. Kotaki M, Tateoka K. A case of migration of a buried lumbar acupuncture needle into abdominal aneurysm [in Japanese].  Pain Clinic. 2002;23:1411-1415.
  16. Yamashita H, Tsukayama H, Tanno Y, Nishijo K. Adverse events in acupuncture and moxibustion treatment: a six-year survey at a national clinic in Japan. J Altern Complement Med. 1999;5:229-236.
  17. Ernst E, White AR. Prospective studies of the safety of acupuncture: a systematic review. Am J Med. 2001;110:481-485.
  18. MacPherson H, Thomas K, Walters S, Fitter M. A prospective survey of adverse events and treatment reactions following 34,000 consultations with professional acupuncturists. Acupuncture Med. 2001;19: 93-102.
  19. White A, Hayhoe S, Hart A, Ernst E. Survey of adverse events following acupuncture (SAFA): a prospective study of 32,000 consultations. Acupuncture Med. 2001;19:84-92.

AUTHOR INFORMATION
Dr Kazutoshi Yokogushi is Vice-Director and Associate Professor in the Division of Rehabilitation, Sapporo Medical University Hospital, in Sapporo, Japan.

Kazutoshi Yokogushi, MD*
Sapporo Medical University Hospital
Minami-1 Nishi-16, Chuo-ku
Sapporo 060-8543, Japan
Phone: 81-01-611-2111  • Fax: 81-01-618-5220
E-mail: yokogushi@sapmed.ac.jp

*Correspondence and reprint requests

 

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