A 54-year-old male underwent a standard L4-L5 discectomy during which the knife blade suddenly broke off. After numerous failed attempts to retrieve the blade under fluoroscopy, the patient was closed, and a CTA was ordered []. When the CTA showed that the knife had migrated in close vicinity to the iliac vein [], the fragment was safely retrieved utilizing a second paravertebral, lateral transpsoas approach performed with a vascular surgeon in attendance [].