Trauma associated with penetrating injuries is on the increase. The instrument used in such attacks is occasionally one that is relatively benign in its normal application. We present this unusual case of penetrating injury to a lumbar vertebra.
A 41-year-old man presented to the Accident and Emergency department following an assault with a screwdriver. The location of the device was apparent (Fig. 1) and initial management according to trauma management guidelines were instigated. The patient remained physiologically stable throughout the initial resuscitation period, with no signs of shock, peritonism, or neurological deficit. He was promptly given broad-spectrum intravenous antibiotics as suggested by local guidelines and administered with anti-tetanus serum. Radiological assessment was performed via plain radiographs and computerised tomography. Precise anatomical detail was provided by computerised tomography which showed the screwdriver to be passing directly through the second lumbar vertebra, with its tip abutting the aorta (Fig. 2). It was clear the aorta had not been penetrated. The patient was admitted and the screwdriver removed with great care under a local anaesthetic and light sedation, as it was felt safer to monitor his neurological status whilst awake. A vascular surgeon remained in attendance throughout the procedure due to the close proximity of the screwdriver to the aorta and inferior vena cava. The wound was debrided and closed with primary suturing. The patient returned to the ward and was monitored with respect to his physiological and neurological status whilst on strict bed rest. Follow-up magnetic resonance imaging did not reveal any significant nerve injury.
Injuries involving screwdrivers, although uncommon, are not rare. The circumstances are often due to an assault on an individual. Impalement involving the cranium,1,2,3 hard palate,4 eye,5 and rectum6 have all been described. Complications following dental procedures where the screwdriver tip has been either been recovered from the caecum,7 or aspirated following radical tumour facial surgery,8 accounts for non-penetrating trauma associated with the instrument. Trauma to the lumbar vertebrae has not been reported previously. The above case demonstrates the importance of strict clinical and radiological assessment in such injuries. The requirement of prompt and thorough evaluation is necessary to avoid harm as treatment may ultimately require the help of specialist intervention or surgery. To remove devices in a setting not equipped for hazardous sequelae is foolhardy. The potential for vascular injury is clearly demonstrated and therefore necessitates early liaison with the appropriate team.
Penetrating trauma to L2 vertebra with no complications
From the provided X-ray and CT images, a segment of high-density metallic foreign body can be seen near the lumbar vertebral body, appearing to penetrate or be embedded. The X-ray plain films show the foreign body in an almost horizontal orientation, with a clear outline consistent with metal instrument density. On the CT axial view, it can be noted entering the vertebral body or pedicle area, causing local destruction of the vertebral bone or interruption of the trabeculae. Additionally, although there is no obvious abnormal mass around the spinal canal, potential vascular or nerve injuries should be monitored. No apparent lumbar instability is noted, but clinical evaluation is required to determine any ligamentous or intervertebral disc injuries.
The above diagnoses are based on the patient’s history of a penetrating injury to the lumbar area and the imaging findings of a metallic foreign body. Attention must be given to the extent of local bone and surrounding soft tissue damage. Key points of differentiation involve evaluating the range of damage caused by the foreign object, local vascular and nerve involvement, and any concurrent fractures or other complications.
Based on the patient’s history of trauma, imaging results, and age factors, the most likely diagnosis is:
Penetrating Screwdriver Injury to the Lumbar Spine (including potential fractures and soft tissue damage).
If subsequent examinations (e.g., angiography, MRI, or endoscopic spinal exploration) indicate injury to nearby major blood vessels or nerve structures, the diagnosis may need revision. However, current information suggests the foreign body primarily affects the vertebral body/pedicle area.
The treatment strategy revolves around removing the foreign body and assessing any potential complications. Specific recommendations are:
Overall, rehabilitation should be conducted under the guidance of a specialist, with a gradual increase in range of motion and weight-bearing intensity. Postoperative healing should be closely monitored for any new neurological symptoms or back pain.
This report provides a reference analysis based on current data and does not replace in-person consultations or professional medical advice. Patients should undergo further evaluations under the direction of specialized physicians, and determine the final treatment and rehabilitation plan according to their actual condition.
Penetrating trauma to L2 vertebra with no complications
