PMC9699854_01
Stabbing in the back of the neck with the screwdriver, with the point of entry just left of the midline.
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F1
A 37-year-old male presented to the emergency department after an assault and injury to the back of the neck with a double-headed screwdriver while the patient was leaning forward [Figure 1].
(a) Sagittal computed tomography (CT) of the cervical spine indicates the position of the tip of the screwdriver at the level of C4. (b) Axial CT of cervical spine scan demonstrating the screwdriver going through the right lamina and entering the dura and the spinal cord, the tip reaching just medial to the lateral mass and transverse foramen.
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F2
(a) Laminectomy of C4-C5 was done, ligamentum flavum was removed, and dural injury was seen in the midline. (b) Following the removal of the screwdriver, damaged tissue of the cord can be seen at the site of injury.
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F3
C1 to C7 with dissection of the fascia and muscle to reach the screwdriver entrance. C4-C5 laminectomy was performed, the ligamentum flavum was removed [Figure 3a], and the midline dural damage was discovered and surgically expanded. The screwdriver was progressively withdrawn parallel to the entrance tract under direct vision, and right hemi-cord damage was noticed [Figure 3b].
Postoperative sagittal T1-weighted magnetic resonance imaging shows a mixed-intensity lesion in the posterior aspect of the cord at the level of C4, suggesting spinal cord contusion.
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F4
The postoperative cervical spine magnetic resonance imaging (MRI) revealed a mixed-intensity lesion in the posterior aspect of the spinal cord at the level of injury, suggesting a spinal cord contusion [Figure 4].