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Review
. 2022 Nov 11:13:520.
doi: 10.25259/SNI_957_2022. eCollection 2022.

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

Muthanna N Abdulqader  1 , Mustafa Ismail  2 , Aktham O Al-Khafaji  2 , Teeba A Al-Ageely  2 , Zahraa M Kareem  2 , Ruqayah A Al-Baider  2 , Sama S Albairmani  3 , Fatimah Ayad  2 , Samer S Hoz  4
Affiliations
Review

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

Muthanna N Abdulqader et al. Surg Neurol Int. .

Abstract

Background: Nonmissile penetrating spine injury (NMPSI) represents a small percent of spinal cord injuries (SCIs), estimated at 0.8% in Western countries. Regarding the causes, an NMPSI injury caused by a screwdriver is rare. This study reports a case of a retained double-headed screwdriver in a 37-year-old man who sustained a stab injury to the back of the neck, leaving the patient with a C4 Brown-Sequard syndrome (BSS). We discuss the intricacies of the surgical management of such cases with a literature review.

Methods: PubMed database was searched by the following combined formula of medical subjects headings, (MESH) terms, and keywords: (((SCIs [MeSH Terms]) OR (nmpsi [Other Term]) OR (nonmissile penetrating spinal injury [Other Term]) OR (nonmissile penetrating spinal injury [Other Term])) AND (BSS [MeSH Terms])) OR (BSS [MeSH Terms]).

Results: A total of 338 results were found; 258 were case reports. After excluding nonrelated cases, 16 cases were found of BSS induced by spinal cord injury by a retained object. The male-to-female ratio in these cases is 11:5, and ages ranged from 11 to 72. The causes of spinal cord injury included screwdrivers in three cases, knives in five cases, and glass in three cases. The extracted data were analyzed.

Conclusion: Screwdriver stabs causing cervical SCIs are extremely rare. This is the first case from Iraq where the assault device is retained in situ at the time of presentation. Such cases should be managed immediately to carefully withdraw the object under direct vision and prevent further neurological deterioration.

Keywords: Brown-Sequard syndrome; Retained foreign body; Screwdriver; Spinal cord injury.

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Conflict of interest statement

There are no conflicts of interest

Figures

Figure 1:
Figure 1:
Stabbing in the back of the neck with the screwdriver, with the point of entry just left of the midline.
Figure 2:
Figure 2:
(a) Sagittal computed tomography (CT) of the cervical spine indicates the position of the tip of the screwdriver at the level of C4. (b) Axial CT of cervical spine scan demonstrating the screwdriver going through the right lamina and entering the dura and the spinal cord, the tip reaching just medial to the lateral mass and transverse foramen.
Figure 3:
Figure 3:
(a) Laminectomy of C4-C5 was done, ligamentum flavum was removed, and dural injury was seen in the midline. (b) Following the removal of the screwdriver, damaged tissue of the cord can be seen at the site of injury.
Figure 4:
Figure 4:
Postoperative sagittal T1-weighted magnetic resonance imaging shows a mixed-intensity lesion in the posterior aspect of the cord at the level of C4, suggesting spinal cord contusion.
See this image and copyright information in PMC

References

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