title: Delayed presentation of deep penetrating trauma to the subaxial cervical spine.
abstract: OBJECTIVE
  To present a rare case of deep penetrating neck trauma in which a retained foreign body in the cervical spine (a broken knife blade) resulted in delayed radicular injury. We describe the surgical management using a retrojugular approach.
  
  
  METHODS
  Our patient sustained a stab wound to the supraclavicular triangle from a small pocketknife. He was initially managed in a local hospital by simple primary wound closure without any radiological examinations, and was discharged home. The patient re-consulted in a delayed fashion with mild local persistent neck pain. Subsequent radiological investigations revealed a foreign body (the broken blade of a pocket knife) embedded in the left neural foramen between the C6 and C7 vertebrae penetrating the disc space. The blade was lying between the left C7 nerve root and the ipsilateral vertebral artery (VA) at the transition of V1 and V2 segments. Initial neurological evaluation was normal. Some days later, the patient developed a delayed left C7 radicular deficit. We undertook urgent exploration along the wound corridor through a retrojugular, transforaminal approach with successful removal of the blade.
  
  
  CONCLUSIONS
  To our knowledge, this is a unique case where a retained foreign body penetrated the soft tissues of the neck, embedding deep in the vertebral column without vascular, aerodigestive or significant primary neurological injury, while causing delayed neck pain and delayed onset radicular injury. We describe our surgical management for removal of the retained blade. The retrojugular approach gives excellent access to all of the important anatomical structures of the neck from an anterolateral approach.
authors.affiliation: Service de Neurochirurgie, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne (Unil), Rue du Bugnon 46, 1011, Lausanne, Switzerland, julienzaldivar@gmail.com.
authors.forename: Julien Francisco
authors.initials: JF
authors.lastname: Zaldivar-Jolissaint
authors.forename: Lukas
authors.initials: L
authors.lastname: Bobinski
authors.forename: Yaelle
authors.initials: Y
authors.lastname: Van Dommelen
authors.forename: Marc
authors.initials: M
authors.lastname: Levivier
authors.forename: Christian
authors.initials: C
authors.lastname: Simon
authors.forename: John Michael
authors.initials: JM
authors.lastname: Duff
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D057210:Delayed Diagnosis; D005547:Foreign Bodies / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D008297:Male; D019838:Neck Injuries / Q000000981:diagnostic imaging* / Q000601:surgery; D011859:Radiography; D013119:Spinal Cord Injuries / Q000000981:diagnostic imaging* / Q000601:surgery; D013124:Spinal Injuries / Q000000981:diagnostic imaging* / Q000601:surgery; D014951:Wounds, Stab / Q000000981:diagnostic imaging* / Q000601:surgery