Guest James D, Luo Zhuojing, Liu Yansheng, Gao Hongkun, Wang Dianchun, Xu Xiao-Ming, Zhu Hui
Neurological Surgery, and the Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, FL, USA.
Department of Orthopedic Spinal Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi Province, China.
Neural Regen Res. 2023 Dec;18(12):2781-2784. doi: 10.4103/1673-5374.373668.
Rarely, penetrating injuries to the spinal cord result from wooden objects, creating unique challenges to mitigate neurological injury and high rates of infection and foreign body reactions. We report a man who sustained a penetrating cervical spinal cord injury from a sharpened stick. While initially tetraparetic, he rapidly recovered function. The risks of neurological deterioration during surgical removal made the patient reluctant to consent to surgery despite the impalement of the spinal cord. A repeat MRI on day 3 showed an extension of edema indicating progressive inflammation. On the 7 day after injury, fever and paresthesias occurred with a large increase in serum inflammatory indicators, and the patient agreed to undergo surgical removal of the wooden object. We discuss the management nuances related to wood, the longitudinal evolution of MRI findings, infection risk, surgical risk mitigation and technique, an inflammatory marker profile, long-term recovery, and the surprisingly minimal neurological deficits associated with low-velocity midline spinal cord injuries. The patient had an excellent clinical outcome. The main lessons are that a wooden penetrating central nervous system injury has a high risk for infection, and that surgical removal from the spinal cord should be performed soon after injury and under direct visualization.
脊髓穿透伤很少由木质物体造成，这给减轻神经损伤以及应对高感染率和异物反应带来了独特挑战。我们报告了一名男子，他因一根削尖的木棍导致颈椎脊髓穿透伤。最初他表现为四肢轻瘫，但功能迅速恢复。尽管脊髓被刺穿，但手术取出过程中神经功能恶化的风险使患者不愿同意手术。伤后第3天的重复磁共振成像（MRI）显示水肿范围扩大，提示炎症进展。伤后第7天，患者出现发热和感觉异常，血清炎症指标大幅升高，随后同意接受手术取出木质物体。我们讨论了与木质物体相关的处理细节、MRI表现的纵向演变、感染风险、手术风险的减轻及技术、炎症标志物谱、长期恢复情况，以及与低速中线脊髓损伤相关的令人惊讶的轻微神经功能缺损。该患者获得了良好的临床结果。主要经验教训是，木质物体穿透性中枢神经系统损伤感染风险高，应在伤后尽快且在直视下进行脊髓内异物的手术取出。
