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  4. Acute penetrating injury of the spinal cord by a wooden spike with delayed surgery: a case report

Acute penetrating injury of the spinal cord by a wooden spike with delayed surgery: a case report

Neural Regeneration Research, 2023 · DOI: https://doi.org/10.4103/1673-5374.373668 · Published: April 10, 2023

Spinal Cord InjuryNeurologyResearch Methodology & Design

Simple Explanation

This case report describes a rare instance of a spinal cord injury caused by a wooden object, specifically a sharpened stick that penetrated the cervical spinal cord of a 23-year-old man. Initially, the patient experienced paralysis in all limbs but quickly regained function. However, due to concerns about potential neurological damage during surgery, the patient hesitated to have the wooden object removed. After developing a fever and new neurological symptoms, the patient agreed to surgery, which led to an excellent clinical outcome. The report emphasizes the high risk of infection associated with such injuries and the need for prompt surgical removal under direct visualization.

Study Duration
1.5 years follow-up
Participants
One 23-year-old male
Evidence Level
Level 4: Case Report

Key Findings

  • 1
    Penetrating spinal cord injuries from wooden objects carry a high risk of infection.
  • 2
    Early surgical removal of the wooden object under direct visualization is recommended to minimize risks.
  • 3
    Standard neurological exams (ISNCSCI) may underestimate the severity of midline penetrating spinal cord injuries.

Research Summary

This case report details the management of a 23-year-old man with a penetrating cervical spinal cord injury from a wooden stick. The patient initially presented with tetraparesis but rapidly recovered function, leading to reluctance towards surgical intervention due to fear of neurological deterioration. However, signs of progressive inflammation and subsequent infection prompted surgical removal of the foreign body on the 7th day post-injury. The surgery was successful, and the patient achieved an excellent clinical outcome. The report emphasizes the importance of early surgical intervention for wooden penetrating spinal cord injuries due to the high risk of infection, even if initial neurological deficits appear minimal. It also notes that standard neurological exams may not fully capture the extent of the injury in such cases.

Practical Implications

Prompt Surgical Intervention

Emphasizes the necessity of early surgical removal of wooden foreign bodies in spinal cord injuries to mitigate infection risks and prevent further neurological decline.

Careful Imaging and Diagnosis

Highlights the importance of using MRI for accurate detection of wooden objects in spinal cord injuries, as CT scans may not always be sufficient.

Awareness of Atypical Presentations

Suggests that clinicians should be aware that midline penetrating spinal cord injuries may present with minimal initial neurological symptoms, requiring a high index of suspicion.

Study Limitations

  • 1
    Single case report limits generalizability
  • 2
    Delay in surgery might have affected the inflammatory response and outcomes
  • 3
    Anterior spinal cord visualization was not possible during surgery

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