Direct withdrawal of a retained foreign body bisecting the thoracic spinal canal in a neurologically intact pediatric patient: illustrative case

J Neurosurg Case Lessons, 2023 · DOI: 10.3171/CASE2363 · Published: June 19, 2023

Spinal Cord Injury Surgery Research Methodology & Design

Simple Explanation

This case report discusses a rare instance of a 10-year-old girl who sustained a non-missile penetrating spinal cord injury (NMPSCI) when she fell on a trophy, resulting in a metal rod bisecting her spinal canal. Despite the rod traversing her spinal canal, the patient showed no neurological deficits. The doctors opted to directly withdraw the foreign body instead of performing open surgery. The patient recovered well, experiencing no complications. The case suggests direct withdrawal may be a viable treatment option for similar cases where patients with retained foreign bodies have no neurological deficits.

Study Duration

6+ Months

Participants

1 pediatric patient

Evidence Level

Level 4: Case Report and Literature Review

Key Findings

1
Direct withdrawal of a retained foreign body (RFB) in a neurologically intact patient with NMPSCI is a viable treatment option.
2
Fast-acting anesthesia without intubation can minimize patient manipulation during RFB removal and allow for quicker neurological assessment.
3
Close follow-up is crucial for early detection of CSF leaks and potential infections post-removal.

Research Summary

The case report presents a rare instance of a 10-year-old female who sustained a non-missile penetrating spinal cord injury (NMPSCI) with a retained foreign body (RFB) bisecting her thoracic spinal canal, yet remained neurologically intact. The patient underwent direct withdrawal of the RFB instead of open surgical exploration, resulting in an excellent clinical outcome. The literature review found few similar cases. The authors suggest that for NMPSCI with RFB and without significant neurological deficits, direct withdrawal may be the best treatment option. They also highlight the benefits of fast-acting anesthesia without intubation.

Practical Implications

Treatment Approach

Direct withdrawal can be considered as a primary treatment option for neurologically intact patients with NMPSCI and RFB, potentially avoiding more invasive surgery.

Anesthesia Management

Using fast-acting anesthesia without intubation minimizes patient manipulation and allows for rapid neurological assessment after RFB removal.

Post-operative Care

Close post-operative monitoring is essential for early detection and management of potential complications such as CSF leaks and infections.

Study Limitations

1
Publication bias may exist, as cases with unsuccessful outcomes are less likely to be published.
2
The case is a rare presentation with only anecdotal evidence, limiting the generalizability of the findings.
3
The foreign body in this case was small and thin, and these recommendations may not be applicable to large or more complex-shaped foreign bodies.

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