| Autor: |
Alan J. Laing, Anne M. Collins, Keith Synnott, John M. Moriarty |
| Rok vydání: |
2008 |
| Předmět: |
|
| Zdroj: |
Injury Extra. 39(2):62-64 |
| ISSN: |
1572-3461 |
| DOI: |
10.1016/j.injury.2007.06.017 |
| Popis: |
While operating a jackhammer, a 39-year-old manstood approximately 100 m behind a diamond wiresaw, a stone cutting device commonly used in thestone quarry industry. The diamond wire (Fig. 1)snapped resulting in high-speed projection of itscomponents including the diamond beads (Fig. 2).One such bead impacted with the patient’s lowerback.On presentation to the National Spinal InjuriesUnit a 1 cm circular puncture wound was noted inthe right paravertebral region at the level of thethirdlumbarvertebra(L3).Neurologicalassessmentrevealed reduced power in the left lower limb, withMedicalResearchCouncil(MRC)gradesoffouroutoffive in knee extension and ankle dorsiflexion andthree out of five in extensor hallicus longus (EHL)and ankle plantar flexion recorded. Voluntary analcontraction was absent.Radiographs of the lumbar spine confirmed thepresence of the diamond bead posterior to the bodyof L3 (Fig. 3). Computed tomography (CT) of thelumbar spine demonstrated a metallic foreign bodywithin the spinal canal at L3. Fragmentation of theright lamina with bony particles within the spinalcanal at this level was also noted (Fig. 4).Pre-operatively tetanus toxoid was administeredin addition to intravenous cefuroxime and gentami-cin. Under general anaesthetic, the patient wasplaced in the prone position. A midline incision,incorporating the puncture wound, was made. Aright paravertebral tract extending through thelamina at L3 was noted. Right L3 laminectomyrevealed a 12 mm dural tear. The diamond beadwas identified within the spinal canal and removed.The nerve roots at this level were intact. The duraltear was repaired using a combination of dural graftmatrix and fibrin glue.A supine position was maintained for 48 h post-operatively and intravenous antibiotics were con-tinued for 7 days. During this time motor function in |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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