Penetrating spinal injury with wooden fragments causing cauda equina syndrome: case report and literature review.
METHODS
Case report.


OBJECTIVE
To report an unusual case of cauda equina syndrome following penetrating injury to the lumbar spine by wooden fragments and to stress the importance of early magnetic resonance imaging (MRI) in similar cases.


BACKGROUND
A 22-year-old girl accidentally landed on wooden bannister and sustained a laceration to her back. She complained of back pain but had fully intact neurological function. The laceration in her back was explored and four large wooden pieces were removed. However 72 h later, she developed cauda equina syndrome. MRI demonstrated the presence of a foreign body between second and third lumbar spinal levels following which she underwent emergency decompressive laminectomy and the removal of the multiple wooden fragments that had penetrated the dura.


RESULTS
Post-operatively motor function in her lower limbs returned to normal but she continued to require a catheter for incontinence. At review 6 months later, she was mobilising independently but the incontinence remained unchanged.


CONCLUSIONS
There are no reported cases in the literature of wooden fragments penetrating the dura from the back with or without the progression to cauda equina syndrome. The need for a high degree of suspicion and an early MRI scan to localise any embedded wooden fragments that may be separate from the site of laceration is emphasized even if initial neurology is intact.
Pal
Debasish
D
Leeds General Infirmary, Neurosurgery, Leeds, United Kingdom. debasishpal@yahoo.co.uk
Timothy
Jake
J
Marks
Paul
P
D000328:Adult; D019299:Decompression, Surgical; D004388:Dura Mater / Q000293:injuries; D004638:Emergency Treatment; D005260:Female; D005547:Foreign Bodies / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D007796:Laminectomy; D007866:Leg / Q000503:physiopathology; D008159:Lumbar Vertebrae / Q000293:injuries*; D008279:Magnetic Resonance Imaging; D009068:Movement; D011128:Polyradiculopathy / Q000209:etiology*; D011183:Postoperative Complications; D011184:Postoperative Period; D014549:Urinary Incontinence / Q000209:etiology; D014934:Wood; D014950:Wounds, Penetrating / Q000150:complications* / Q000175:diagnosis