Abstract
Purpose
To detail the management, complications and results of a crossbow arrow injury, where the broadhead went through the mouth, tongue, soft palate, C2 vertebra, spinal canal, dural sack, exiting the neck posteriorly and the arrow shaft lodged in the spine causing mild spinal cord injury.
Methods
Case presentation.
Results
A penetrating axial cervical spine crossbow injury was treated successfully in spite of the following interdisciplinary complications: meningitis, cerebrospinal fluid leakage, re-bleeding, and cardiac arrest. The shaft was removed from the neck, and C1-3 dorsal stabilization was performed. Controlled Computed Tomography (CT) showed adequate implant position. After 4 months the patient’s fine motor skills improved, and he became able to button his shirt on his own, and to eat and drink without any help. Additionally, he was able to walk without any support. At the time of control at the outpatient clinic his behavior was adequate: he cooperated with the examining doctor and answered with short sentences although his psychomotor skills were slightly slower.
Conclusions
Although bow and crossbow spine injuries are rare nowadays they still occur. The removal of a penetrating missile resulting in such a spinal injury required a unique solution. General considerations, such as securing the airway, leaving the penetrating arrow in the neck and immobilizing both the arrow and neck for transport, thorough diagnostic imaging, preventing cerebrospinal fluid leakage, administering prophylactic antibiotics with broad coverage and stabilizing the spine if required, are advised.
References
Salvino CK, Origitano TC, Dries DJ, Shea JF, Springhorn M, Miller CJ (1991) Transoral crossbow injury to the cervical spine: an unusual case of penetrating cervical spine injury. Neurosurgery. 28(6):904–907
Pomara C, Karch SB, Mallegni F, Marrone A, Ricci S, Riezzo I, Fineschi V (2008) A medieval murder. Am J Forensic Med Pathol 29(1):72–74
Skadorwa T, Ciszek B (2013) Pediatric arrowshot injury to cervical spinal cord-sagittal cord transection with no neurological deficit and good outcome: case report and review of literature. Childs Nerv Syst 29(10):1933–1939
Geissinger G, Magid GA, McMahon RC (2009) Arrow trauma to cervical spine. WMJ 108(4):197–199
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The author declares that he have no conflict of interest.
Rights and permissions
About this article
Cite this article
Kovari, V.Z. Successfully treated transoral crossbow injury to the axial spine causing mild neurologic deficit: case presentation. Eur Spine J 26 (Suppl 1), 24–30 (2017). https://doi.org/10.1007/s00586-016-4620-3
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-016-4620-3