Retained Glass Fragment in the Cervical Spinal Canal in a Patient with Acute Transverse Myelitis: A Case Report and Literature Review

Abstract

A 50-year-old male presented with a one-day history of right leg weakness, numbness, and urinary retention. Weakness was present for two weeks but worsened significantly during the last 24 hours. On the right there was sensory loss in the leg and below the Th8 dermatome. On the left there was sensory loss below the Th10 dermatome and distal loss of temperature sensation. Past medical history revealed a cervical trauma 30 years ago when a glass chip lodged into the left side of the neck. The patient did not seek medical attention after removing it himself. No neurological symptoms followed the incident. No cervical manipulation or other physical trauma occurred before current symptom onset. Magnetic resonance (MR) imaging showed features consistent with myelitis at the level of C4–Th3. At the level of C6–C7, a T1 and T2 hypointense lesion was noted. On computed tomography, this lesion was hyperdense and occupied the spinal canal and the left intervertebral foramen. It was deemed to be a glass fragment. Surgical removal was withheld because the fragment was clinically silent for 30 years, the risk of surgical removal would outweigh the benefits and the patient did not prefer surgical treatment. Acute demyelinating transverse myelitis was diagnosed and treated with methylprednisolone. 10 months later MR features of myelitis resolved and the patient's neurological condition improved. Our case shows that foreign bodies in the cervical spinal canal can remain asymptomatic for up to 30 years. In the case of a long asymptomatic retention period the need for surgical removal of a foreign body must be carefully evaluated, taking into account the probability that a foreign body is the cause of current symptoms, risk of a foreign body causing damage in the future, risk of damage to the spinal cord during removal, and probability of therapeutic success.

Brown-Sequard syndrome associated with a spinal cord injury caused by a retained screwdriver: A case report and literature review

“…Improvement was observed during the follow-up period in 12 of the reported cases, while three of the cases reported no improvement in motor and sensory functions or deterioration postoperatively [ Table 1 ]. [ 5 , 8 , 13 , 14 , 16 , 23 , 29 , 33 , 36 ]…”

“…Meena et al, 2016 [25] 20/M BSS T12 Screwdriver Surgical intervention for the retrieval of the screwdriver Improvement Jesmanas et al, 2018 [14] 50/M Weakness and sensory loss in the lower limb C6-C7 Glass chip Conservative treatment due to the risks of surgery Slight improvement in motor function.…”

Foreign Glass Bodies in Pleura and Pancreas: Systematic Review for Entry Hypotheses and Treatment Options in an Unresolved Case

“…It is entirely possible that the accident responsible for these foreign bodies occurred many years or even decades prior. There are documented cases where glass fragments, in particular, were discovered a significant number of years after their initial incorporation, ranging from 10 to 30 years 18,86–88 . Scars resulting from glass shard injuries may gradually shrink over time 15 and wounds caused by glass impalement are often superficially cleaned without an in-depth assessment of potential foreign body retention.…”

“…There are documented cases where glass fragments, in particular, were discovered a significant number of years after their initial incorporation, ranging from 10 to 30 years. 18,[86][87][88] Scars resulting from glass shard injuries may gradually shrink over time 15 and wounds caused by glass impalement are often superficially cleaned without an in-depth assessment of potential foreign body retention. In fact, there are at least 7 known cases where relatively large glass shards deep within the body were overlooked.…”

Recovery after inadvertent intramedullary microchip implantation at C1–C2 in a kitten

“…19,23 Although our cat demonstrated a favourable outcome with medical management, the clinician should be aware of late-onset complications in patients with central nervous system (CNS) foreign body diseases. Migration of foreign bodies, 13,24,25 inflammatory reactions like granuloma [26][27][28][29][30] and abscess formation, [31][32][33] myelitis, 34 arachnoiditis with and without subsequent subarachnoid diverticula or syrinx formation 35,36 and CSF leakage 37 have been reported in veterinary and human medicine. In our cat, some degree of migration of the microchip was identified on follow-up CT that might have occurred in the context of maturing of the spine.…”