Supit Tommy, Risdianto Ajid, Priambada Dody, Arifin Muhamad Thohar, Brotoarianto Happy Kurnia
Department of General Surgery, Faculty of Medicine, Diponegoro University, Semarang, Indonesia.
Department of Neurosurgery, Neurospine Division, Faculty of Medicine, Diponegoro University, Semarang, Indonesia.
Int J Surg Case Rep. 2020;68:174-177. doi: 10.1016/j.ijscr.2020.02.063. Epub 2020 Mar 3.
Penetrating cervical spinal cord injury (SCI) is a rare clinical entity that requires a multitude of health care specialists for proper management. The unpredictable nature of penetrating SCI and complex systemic sequela contribute to the high mortality rates of penetrating SCI.
An 18-year-old-male patient was admitted to the emergency department with tetraparesis following a penetrating injury to the neck. Radiological examination revealed fractures of C4 and C5 spinous processes and extensive intradural pneumorrhachis. The patient was managed operatively with laminectomy, vertebral augmentation, and duroplasty. An acute decreased level of consciousness was observed four days after the operation. Laboratory investigation revealed critically low plasma sodium level. The patient remained decerebrated despite electrolyte correction and pronounced brain dead on the seventh postoperative day.
Metabolic derangements and pulmonary physiologic changes following trauma are lethal complications. Hyponatremic encephalopathy and disrupted pulmonary function caused by high cervical compression by the extensive pneumorrhachis contributes to the morality in this case report.
This case report presents a rare clinical entity along with its' complications. Prompt clinical stabilization, strict biochemical monitoring, and multidisciplinary care from health care specialists are mandatory for SCI patients.
穿透性颈脊髓损伤（SCI）是一种罕见的临床病症，需要众多医疗保健专家进行妥善管理。穿透性SCI的不可预测性和复杂的全身后遗症导致了其高死亡率。
一名18岁男性患者因颈部穿透伤后出现四肢瘫而被收入急诊科。影像学检查显示C4和C5棘突骨折以及广泛的硬膜内脊髓积气。患者接受了椎板切除术、椎体强化术和硬脊膜成形术等手术治疗。术后四天观察到患者意识水平急性下降。实验室检查显示血浆钠水平极低。尽管进行了电解质纠正，但患者仍处于去大脑状态，并在术后第七天被宣布脑死亡。
创伤后的代谢紊乱和肺部生理变化是致命并发症。本病例报告中，广泛的脊髓积气导致的高颈段压迫引起的低钠血症性脑病和肺功能紊乱是导致死亡的原因。
本病例报告展示了一种罕见的临床病症及其并发症。对于SCI患者，迅速的临床稳定、严格的生化监测以及医疗保健专家的多学科护理是必不可少的。
