Thorn in My Spine: A case of a retained intradural extramedullary foreign body

Reddy, Neelima G.; Fata, Peter; Balzer, Anthony; Diaz-Marchan, Pedro J.; Lincoln, Christie M.

doi:10.1016/j.clinimag.2017.05.011

Cited by 4 publications

(5 citation statements)

References 22 publications

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“…The "Spring Phenomenon" says the long-lasting FB could penetrate into the intra-dural space, gradually close to the cord and nerve roots [18]. Sometimes in Para-vertebral soft tissues and extra-medullary space, pieces of surgical equipments can retain which mimics with neoplasm [19]. In case of acute penetrating injury or suspected metallic FB, CT and Radiographs are considered to be a safe option [19].…”

Section: Discussionmentioning

confidence: 99%

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Retained Metallic Part of a Dislodged Knife in the Thoracic Spine with Paraparesis

Antara¹,

Dey²,

MSH³

et al. 2022

SCR

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The incidence of traumatic spinal cord injury is reported as 30-40 million per year. Among these, stab wounds to the spinal canal are usually rare. These injuries often lead to complete or incomplete neurological deficits. An appropriate management can ensure good functional recovery for approximately two-third of the patient. As these cases are uncommon, their treatment protocols are still controversial and under evaluation. Some literatures reveal various surgical approaches. Spinal canal injury with retained part of the causative agent (knife, bullet, glass etc.) or any other complication on the wound site demands immediate surgical exploration. Here we report on a patient with a retained metallic foreign body (tip of knife) in the thoracic region traversing the left pedicle of sixth thoracic vertebrae along with spinal canal with paraparesis and after neuro-surgical exploration and complete removal of the foreign body, patient shows gradual improvement of neuro-functional status. Proper wound care and long term close follow up was ensured during post operative period.

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Section: Discussionmentioning

confidence: 99%

“…Sometimes in Para-vertebral soft tissues and extra-medullary space, pieces of surgical equipments can retain which mimics with neoplasm [19]. In case of acute penetrating injury or suspected metallic FB, CT and Radiographs are considered to be a safe option [19].…”

Section: Discussionmentioning

confidence: 99%

Retained Metallic Part of a Dislodged Knife in the Thoracic Spine with Paraparesis

Antara¹,

Dey²,

MSH³

et al. 2022

SCR

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“…[ 1 ] Several cases were also reported of spinal foreign body granulomas from retained pieces of surgical instruments in the paravertebral soft tissues and extramedullary space, which are sometimes confused with neoplasm. [ 3 ] CT and radiographs are considered the first line imaging modalities when dealing with acute penetrating injury or suspected metallic foreign body, although MR has been shown to be a safe option. [ 3 ] However, MR can fail to show the foreign body when it is small or nonferromagnetic.…”

Section: Discussionmentioning

confidence: 99%

“…[ 3 ] CT and radiographs are considered the first line imaging modalities when dealing with acute penetrating injury or suspected metallic foreign body, although MR has been shown to be a safe option. [ 3 ] However, MR can fail to show the foreign body when it is small or nonferromagnetic. [ 3 ]…”

Section: Discussionmentioning

confidence: 99%

Retained foreign needle in the thoracic spinal canal in a child: Case report

Kawtharani¹,

Bsat²,

Houshiemy³

et al. 2021

Surgical Neurology International

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Background: The presence of retained foreign bodies in the spinal canal has been reported in the literature. They are attributed to retained pieces of medical equipment after surgery, or, following trauma, to residual bullets, glass fragments, or knife blades. Although some retained materials do not cause any neurological deficits in the short run, others may become symptomatic months later. Case Description: A 2-year-old male presented with a history of intermittent fever and mild lower extremity weakness. Notably, the original infectious workup was negative. However, a noncontrast CT scan later documented a needle-shaped foreign body in the spinal canal at the T10 level. During the T10 laminectomy, a needle (i.e. from a medical syringe) was removed, the patient remained neurologically intact. The foreign body turned out to be a medical syringe needle tip. Conclusion: A 2-year-old male presented with fevers and mild lower extremity weakness attributed to an intraspinal needle tip found utilizing CT at the T10 level. T10 laminectomy allowed for removal of a small needle tip. This shows the importance of removing retained spinal foreign bodies to avoid further/future neurological injury, and/or the potential risks/complications of foreign body migration/sequestration.

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“…The majority of papers examining substance visibility were focused primarily on locating a variety of penetrating or ingested foreign bodies and just a few papers explored implanted marker options for tumour boundary markers prior to excision or radiotherapy planning 3 5–7 9. Foreign bodies that had been located, ranged in material from fish and chicken bones, batteries, plastics, coins, metal and wood splinters10–13 and it should be noted that some materials were missed even with the high sensitivity of modern MRI and CT 14 15. Pattamapospong et al 16 published results regarding the visibility of a number of substances on X-ray, CT and MRI and demonstrated a 100% specificity but only 58% sensitivity for fresh wood, dry wood, glass, plastic and porcelain using MRI.…”

Section: Introductionmentioning

confidence: 99%

Determining a reliably visible and inexpensive surface fiducial marker for use in MRI: a research study in a busy Australian Radiology Department

et al. 2019

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ObjectivesSingle-use commercial surface fiducial markers are used in clinical imaging for a variety of applications. The current study sought to find a new, reliably visible, easily sourced and inexpensive fiducial marker alternative for use with MRI.DesignFive commonly requested MRI sequences were determined (three-dimensional (3D) T1-weighted, T1 coronal, 3D T2-weighted, T2 fat suppressed, proton density), to examine the visibility of 18 items (including a commercial fiducial marker).SettingClinical 3T MRI scanner in an Australian Tertiary Hospital and an Australian University Biomedical Engineering research group.Interventions18 marker alternatives were scanned using five common MRI sequences. Images were reformatted to obtain both an image through the mid-height of each marker and a maximum intensity z-projection image over the volume of the marker. Variations in marker intensity were profiled across each visible marker and a visibility rating defined.Main outcome measuresOutcome measures were based on quantitative assessment of a clear intensity contrast ratio between the marker and the adjacent tissue and a qualitative assessment of visibility via a 3-point scale.ResultsThe fish oil capsule, vitamin D capsule, paint ball pellet, soy sauce sushi tube and commercial markers were typically visible to a high quality on all the imaging sequences and demonstrated a clear differential in intensity contrast against the adjacent tissue. Other common items, such as plasticine ‘play doh’ and a soft ‘Jelly baby’ sweet, were surprise candidates, demonstrating high-quality visibility and intensity contrast for the 3D T1-weighted sequence.ConclusionsDepending on the basis for referral and MRI sequence chosen, four alternative fiducial markers were determined to be inexpensive, easily sourced and consistently visible. Of these, the vitamin D capsule provided an excellent balance between availability, size, cost, usability and quality of the visualised marker for all the commonly used MRI sequences analysed.

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Thorn in My Spine: A case of a retained intradural extramedullary foreign body

Cited by 4 publications

References 22 publications

Retained Metallic Part of a Dislodged Knife in the Thoracic Spine with Paraparesis

Retained Metallic Part of a Dislodged Knife in the Thoracic Spine with Paraparesis

Retained foreign needle in the thoracic spinal canal in a child: Case report

Determining a reliably visible and inexpensive surface fiducial marker for use in MRI: a research study in a busy Australian Radiology Department

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