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 injury to L2 vertebra with no complications
According to the provided X-ray and CT images, a metallic foreign body can be seen penetrating the lumbar vertebral body (located in the mid-lumbar region, with the foreign body inserted from the dorsal side toward the front, presenting an irregular rod/strip-shaped image, suspected to be a screwdriver or a similar tool). Specifically:
Based on the patient's history of trauma and the imaging findings, the possible diagnoses or differentials include:
These differentials are primarily based on the visible shape of the foreign body on imaging, associated vertebral fracture, and the extent of surrounding tissue involvement. If there are neurological symptoms or clinical signs of vascular injury, further assessment is required to exclude vascular or dural injury.
Considering the 41-year-old male patient’s history of trauma and imaging findings indicating a foreign body penetrating the lumbar vertebra, the most likely diagnosis is:
“Penetrating Lumbar Spine Injury (Screwdriver Insertion)”
Further angiographic studies (or CTA/MRA) and neurological assessment are advised to determine any vascular or nerve involvement. If imaging or clinical information is incomplete, other potential combined injuries must be ruled out.
Treatment Strategy:
Rehabilitation and Exercise Prescription (FITT-VP Principle):
During the recovery process, if there is a marked increase in pain or any new neurological symptoms (numbness, weakness, bowel or bladder dysfunction), seek medical attention promptly or halt more intensive training to prevent secondary injury.
This report is a reference-based medical analysis derived from the available information and should not replace in-person consultation or professional medical advice. The specific treatment and rehabilitation plan should be adjusted based on the patient’s clinical condition, intraoperative findings, and follow-up results.
Penetrating injury to L2 vertebra with no complications
