[Transfixion of cervical cord by a glass fragment--report of a case (author's transl)]

Abstract

Stab wound of the spinal cord caused by accident occurred in the home life is rare absolutely. One case of stab wound of the cervical spinal cord caused by penetrated and retained glass fragment within the spinal canal was reported. A 30-year-old woman was hospitarized on August 16, 1971. with complaint of left hemiparesis, gait disturbance and sensory impairment on the right side. A glass door fell down on the patient's neck on April 14, 1971. and one glass fragment was removed from the patient's left neck by one of the patient's family and no immediate spinal cord symptom appeared and no physician was consulted at that time. One and a half month after the injury the patient rod a motor bicycle and pain and severe stiffness in the shoulder and neck, and headache. These subjective symptom disappeared by rest and same subjective symptom repeated in following five days. Three and a half months after the injury the patient found sensation loss in the right foot and gait distrubance appeared. After the sensory impairment extended to the cervical level which was accompanied by left hemiparesis. On examination, the patient was found to have merked weakness of left limbs, spastic gait and severe impairment of touchpain- and thermosensation below the fifth cervical level but deep sensation was preserved. All tendon reflexes showed marked exaggeration and pathological reflexes were proved. Roentgenograms of the cervical spine revealed a long triangular glass fragment which had been retained in the spinal canal between the first and second cervical vertebrae. The air myelogram suggested the glass fragment had transfixed the cervical spinal cord. Laminectomy was performed and the glass fragment which had a shape of a sharp pointed surgical knife was removed by gentle move in the opposite direction of invation. Following removal of the foreign body, the patient's left hemiparesis recovered to normal state at four months after the operation and right sensory impairment also improved. The cervical spinal cord may be injured in the following way: the right lateral spinothalamic tract may be injured by the skewer injury due to glass fragment but injury of the left same tract may be avoided because of oblique direction of penetration of the glass fragment in the spinal cord. On the other hand, the left pyramidal tract may be compressed by glass fragment and not injured, because left hemiparesis recovered very well postoperatively.