A foreign body in the spinal canal

Abstract

A n 18-year-old man who presented with weakness in his lower limbs, had an upper motor neurone lesion at the D12-L1 level. At laminectomy two stone-like objects were found which proved to be bundles of tiny pieces of wood. They are thought to have entered the cord through an abdominal penetrating injury sustained six years previously.J Bone Joint Surg [Br] 2000;82-B:267-8. Received 14 April 1999; Accepted 24 June 1999 We describe a patient with a foreign body resembling a 'stone' in the spinal cord. Details of the probable aetiology and pathogenesis are given. Case reportAn 18-year-old man presented with difficulty in walking due to weakness of his lower limbs which had been present for six months and had become progressively worse. He had had difficulty in passing urine for 15 days. There was no pyrexia or constitutional symptoms. On examination he had an upper motor neurone lesion corresponding to the level of D11.Six years previously he had fallen from a tree in a field and landed on sharp shoots which were remnants of the cut stems of sugar cane. He sustained a penetrating injury of the abdomen. An exploratory laparotomy had been carried out. He had an associated compression fracture in the dorsolumbar region. He recovered in six weeks and was well for six years.Examination revealed a kyphotic deformity of the dorsolumbar spine. He had upper motor neurone paraparesis with grade-3 power at the hip, knee and ankles and grade-2 power of extensor hallucis longus and flexor hallucis longus. He had hypoaesthesia in the L2, L3 and L4 dermatomes and loss of proprioception.Routine haematological investigations were normal. The Mantoux test was negative. Plain radiographs showed wedging at the level of D11 and 12 with posterior scalloping and a widened interpedicular distance at these levels. MRI and CT were not done.Myelography revealed total obstruction at L1 with widening of the dye column, consistent with an intradural lesion (Fig. 1). Examination of the CSF showed xanthochromia. In view of the clinical and myelographic diagnosis of obstruction at L1, the patient had a spinal decompression and a laminectomy from D11 to L2. The ligamentum flavum was hypertrophied. It was dirty yellow in colour with a firm fusiform swelling. The dura was adherent from D11 to L1. An incision was made in the thickened dura but there was no leakage of CSF. There was a solid mass of tissue and, with difficulty, a plane of cleavage was developed with blunt dissection to expose the swelling. Two black, rounded hard structures were encountered which were stone-like and surrounded by a foreignbody granuloma (Fig. 2a). They were excised and produced a metallic sound when dropped into a steel container. The

Acute onset quadriparesis as a sequela to an oropharyngeal stick injury

“…A review of the human literature reveals large series reports of intentional injury to the spinal cord from ballistic or stab wounds but there are few reports of accidental injury. One such report describes a foreign body reaction to a wooden fragment within the vertebral canal resulting in myelopathy a number of years after an abdominal penetrating injury (Lunawat and Taneja 2000). A further report describes acute onset myelopathy in a man involved in a road traffic accident during which a wooden fence stake penetrated the thoracic spinal cord.…”

“…Vadasz and others (1996) recommend the use of MRI in the investigation of patients who have suffered penetrating trauma and have associated clinical signs of spinal cord dysfunction. Myelography has been used with success in both human and veterinary patients in localising foreign material within the epidural space (Jones and Woosley 1981, Brockman and Trout 1991, Lunawat and Taneja 2000 and, in this case, it provided a rapid and accurate aid to lesion localisation.…”

“…Accidental penetrating injuries of the vertebral canal are extremely uncommon. A review of both the human and the veterinary literature reveals only a few such documented cases (Cabezudo and others 1980, Baghai and Sheptak 1982, Sawar and others 1993, Vadasz and others 1996, Lunawat and Taneja 2000, the majority of which are associated with subacute or chronic onset of neurological deficits. This report describes a case of acute onset quadriparesis following an oropharyngeal penetrating injury in a dog.…”

Delayed presentation of a thorn prick as an intramedullary abscess

“…[10] We couldn't find any case report where a thorn of Acacia was implanted in the cord, but there has been a case report of a sharp sugar cane piece causing cord compression six years following trauma. [5] …”

“…[1] Bullet injuries to the spine and spinal cord have been adequately covered in literature. However, other types of foreign bodies are also responsible for the penetrating injuries to the spine, for example knife, [2] fragment of glass, [2] nail, [3] pencil lead, [4] and sugar cane [5] which may present months to years after the injury due to reactive tissue formation. We herein present a case of intramedullary abscess formation due to a retained thorn of Acacia.…”