Abstract
Study design: Case report Objective: To report an unusual case of cauda equina syndrome following penetrating injury to the lumbar spine by wooden fragments and to stress the importance of early magnetic resonance imaging (MRI) in similar cases. Summary of background data: A 22-year-old girl accidentally landed on wooden bannister and sustained a laceration to her back. She complained of back pain but had fully intact neurological function. The laceration in her back was explored and four large wooden pieces were removed. However 72 h later, she developed cauda equina syndrome. MRI demonstrated the presence of a foreign body between second and third lumbar spinal levels following which she underwent emergency decompressive laminectomy and the removal of the multiple wooden fragments that had penetrated the dura. Results: Post-operatively motor function in her lower limbs returned to normal but she continued to require a catheter for incontinence. At review 6 months later, she was mobilising independently but the incontinence remained unchanged. Conclusion: There are no reported cases in the literature of wooden fragments penetrating the dura from the back with or without the progression to cauda equina syndrome. The need for a high degree of suspicion and an early MRI scan to localise any embedded wooden fragments that may be separate from the site of laceration is emphasized even if initial neurology is intact.
References
Baghai P, Sheptak PE (1982) Penetrating spinal injury by a glass fragment: case report and review. Neurosurgery 11(3):419–422
Cybulski GR, Stone JL, Kant R (1989) Outcome of laminectomy for civilian gunshot injuries of the terminal spinal cord and cauda equina: review of 88 cases. Neurosurgery 24(3):392–397
Ginsberg LE, Williams DW III, Mathews VP (1993) CT in penetrating craniocervical injury by wooden foreign bodies: reminder of a pitfall. Am J Neuroradiol 14(4):892–895
Harrop JS, Hunt GE Jr, Vaccaro AR (2004) Conus medullaris and cauda equina syndrome as a result of traumatic injuries: management principles. Neurosurg Focus 15, 16(6):e4
Heary RF, Vaccaro AR, Mesa JJ, Balderston RA (1996) Thoracolumbar infections in penetrating injuries to the spine. Orthop Clin North Am 27(1):69–81
Imokawa H, Tazawa T, Sugiura N, Oyake D, Yosino K (2003) Penetrating neck injuries involving wooden foreign bodies: the role of MRI and the misinterpretation of CT images. Auris Nasus Larynx 30(Suppl):S145–147
Levy ML, Gans W, Wijesinghe HS, Stillerman CB et al (1996) Use of methylprednisolone as an adjunct in the management of patients with penetrating spinal cord injury: outcome analysis (discussion 1148–1149) Neurosurgery 39(6):1141–1148
Little J, DeLisa J (1986) Cauda equina injury: late motor recovery. Arch Phys Med Rehabil 67:45–47
Lunawat SK, Taneja DK (2000) A foreign body in the spinal canal: a case report. J Bone Joint Surg Br 82(2):267–268
Opel DJ, Lundin DA, Stevenson KL, Klein EJ (2004) Glass foreign body in the spinal canal of a child: case report and review of the literature. Pediatr Emerg Care 20(7):468–72
Qian T, Guo X, Levi AD, Sipski ML et al (2005) High-dose methylprednisolone may cause myopathy in acute spinal cord injury patients. Spinal Cord 43(4):199–203
Robertson DP, Simpson RK (1992) Penetrating injuries restricted to the cauda equina: a retrospective review (discussion 269–270) Neurosurgery 31(2):265–269
Rubin G, Tallman D, Sagan L, Melgar (2001) An unusual stab wound of the cervical spinal cord: a case report. Spine 15, 26(4):444–447
Simpson RK Jr, Venger BH, Narayan RK (1989) Treatment of acute penetrating injuries of the spine: a retrospective analysis. J Trauma 29(1):42–46
Stauffer E, Wood R, Kelly E (1979) Gunshot wounds of the spine The effects of laminectomy. J Bone Joint Surg 61A:389–392
Steinmetz, Michael P, Krishnaney, Ajit A, McCormick, William, Benzel, Edward C (2004) Penetrating spinal injuries. Neurosurg Q.14 (4):217–223
Thakur RC, Khosla VK, Kak VK (1991) Non-missile penetrating injuries of the spine. Acta Neurochir (Wien) 113(3–4):144–148
Velmahos GC, Degiannis E, Hart K, Souter I, Saadia R (1995). Changing profiles in spinal cord injuries and risk factors influencing recovery after penetrating injuries. J Trauma 38(3):334–337
Wang JC, Bohlman HH, Riew KD (1998) Dural tears secondary to operations on the lumbar spine. Management and results after a two-year-minimum follow-up of eighty-eight patients. J Bone Joint Surg Am 80(12):1728–1732
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Pal, D., Timothy, J. & Marks, P. Penetrating spinal injury with wooden fragments causing cauda equina syndrome: case report and literature review. Eur Spine J 15 (Suppl 5), 574–577 (2006). https://doi.org/10.1007/s00586-005-0026-3
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-005-0026-3