Cervical intradural glass fragment: a rare cause of neuropathic pain

Abstract

Intradural foreign bodies after penetrating injuries are seen very rarely. Limited number of cases of glass fragments in the spinal canal were reported previously. Migration of foreign bodies and delayed onset of neurological symptoms due to foreign bodies were also reported. In this report a 33-year-old male patient was presented, who had penetration of glass fragments through oropharyngeal mucosa in to the spinal canal after crashing into a glass door. Glass fragment, which migrated through an unusual route, and reached cervical spinal intradural space, caused neuropathic pain with radicular symptoms, 21 years after the initial injury. This case report emphasize that after penetrating injuries of spine, foreign bodies may remain silent until the patient became symptomatic years after the initial injury and these foreign bodies may migrate to extreme distant and unexpected locations in the central nervous system. KeywoRds: Intradural foreign bodies, Migration, Glass, Neuropathic pain ÖZ Delici-kesici yaralanmalar sonrası intradural yabancı cisimler oldukça nadirdir. Omurilik kanalı içerisinde yabancı cisim olarak cam parçası görülmesi ve bunun yer değiştirerek geç dönemde semptomlara yol açması daha da nadirdir. Bu çalışmada, omurilik kanalı içerisinde yer değiştiren cam parçasına bağlı geç dönemde şikayetleri ortaya çıkan 33 yaşında bir erkek hasta sunulmuş; nadir görülmesi ve genel tecrübeye katkıda bulunmak amacıyla tartışılması amaçlanmıştır. Hastanın 21 yıl önce cam kapıya çarpma sonrası ağız mukozasına cam parçaları saplandığı öğrenilmiş ve bu parçaların servikal spinal intradural mesafeye ulaşarak hastada radiküler bulgularla birlikte nöropatik ağrıya sebep olduğu görülmüştür. Omuriliğin delici-kesici yaralanmalarında nadir de olsa yabancı cisimlerin omurilik kanalında kalabileceği ve bunların hem medüller hem de radiküler bulgulara yol açabileceği unutulmamalıdır. Orofarinks mukozasının delici-kesici yaralanmalarında da yabancı cisimlerin omurilik kanalına ulaşarak, erken dönemde veya yer değiştirme sonrası geç dönemde klinik bulgular ortaya çıkartabileceği gözden kaçırılmamalıdır.

Neurological recovery after traumatic Cauda Equina syndrome due to glass fragments: An unusual case

“…CT can also show the trajectory of the injury. [4,5] MRI can also provide precise data about the location of glass fragments. [5] In our case, CT scan demonstrated the glass fragment adjacent to lamina, and then the MRI showed that the glass fragment was located intradurally.…”

“…During closure of the dura, removal of hematoma, bone fragments, and foreign bodies is important to lower the risk of infectious complications. [4,5] Neurological deficits related to direct injury are usually evident immediately after the trauma. Severe initial neurological deficits rarely improve after decompressive surgery.…”

“…Delayed deficits may occur because of infection, granuloma formation, iron encrustation, or direct contact of the glass fragments with neural tissue. [3,5] Both plain radiographs and CT are fast and effective imaging modalities for demonstrating metallic and glass foreign bodies. CT can also show the trajectory of the injury.…”

“…[1] Good functional recovery is related to rapid, aggressive decompressive surgery of the Cauda Equina region. [4,5] Wide surgical exposure enables safe removal of intradural foreign bodies under direct visualization after the lamina is partially or totally removed. [3] Failure to remove a retained foreign body from within the spinal canal may result in cerebrospinal fluid leak, osteomyelitis, meningitis, migration of the foreign body, and/or progressive neurological deficits.…”

The Study of Different Approaches of Parecoxib Sodium Pretreatment on the Behavior of Rats with Neuropathic Pain

“…However, the pathogenesis of neuropathic pain remains elusive [1][2][3]. It is generally agreed that neuropathic pain could be induced by multiple factors [4][5][6][7]. Thus, the diagnosis and clinical treatment for neuropathic pain is still challenging but the results are still not satisfactory [1,[8][9][10]].…”