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


      • Patient with long-term back pain developed acute neurologic symptoms without recent penetrating spinal injury.
      • Initial thoracic spine MRI demonstrated enhancing intradural extramedullary lesion concerning for aggressive neoplasm.
      • Surgical resection demonstrated a retained foreign body with surrounding inflammatory changes.
      • Similar cases and MRI imaging characteristics of penetrating foreign bodies are reviewed.


      Foreign bodies in the spine are most commonly traumatic and managed in an acute setting. A few case reports describe foreign bodies resulting in delayed neurologic dysfunction, most commonly iatrogenic or from penetrating injury. We present a 30-year old man with lower extremity weakness from an intradural extramedullary foreign body granuloma secondary to a thorn, which was initially thought to represent an aggressive malignant process with intra and extramedullary involvement on MR. Postoperatively, the patient endorsed a causative trauma several years prior. We also present a review of the few similar published cases as well as the described prototypical imaging features and pathologic process.


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        • Devivo M.J.
        Epidemiology of traumatic spinal cord injury: trends and future implications.
        Spinal Cord. 2012; 50: 365-372
        • McCaughey E.J.
        • Purcell M.
        • Barnett S.C.
        • Allan D.B.
        Spinal cord injury caused by stab wounds: incidence, natural history, and relevance for future research.
        J Neurotrauma. 2016;
        • Shahlaie K.
        • Chang D.J.
        • Anderson J.T.
        Nonmissile penetrating spinal injury. Case report and review of the literature.
        J Neurosurg Spine. 2006; 4: 400-408
        • Opel D.J.
        • Lundin D.A.
        • Stevenson K.L.
        • Klein E.J.
        Glass foreign body in the spinal canal of a child: case report and review of the literature.
        Pediatr Emerg Care. 2004; 20: 468-472
        • Yoshioka K.
        • et al.
        A glass foreign body migrating into the lumbar spinal canal: a case report.
        J Orthop Surg (Hong Kong). 2012; 20: 257-259
        • Jones F.D.
        • Woosley R.E.
        Delayed myelopathy secondary to retained intraspinal metallic fragment. Case report.
        J Neurosurg. 1981; 55: 979-982
        • Wu W.Q.
        Delayed effects from retained foreign bodies in the spine and spinal cord.
        Surg Neurol. 1986; 25: 214-218
        • Fung C.F.
        • Ng T.H.
        Delayed myelopathy after a stab wound with a retained intraspinal foreign body: case report.
        J Trauma. 1992; 32: 539-541
        • Kulkarni A.V.
        • Bhandari M.
        • Stiver S.
        • Reddy K.
        Delayed presentation of spinal stab wound: case report and review of the literature.
        J Emerg Med. 2000; 18: 209-213
        • Wang H.
        • Ma L.
        • Ding W.-Y.
        Delayed myelopathy secondary to stab wound with a retained blade tip within the laminae: case report.
        Int J Clin Exp Med. 2015; 8: 16787-16792
        • Peacock W.J.
        • Shrosbree R.D.
        • Key A.G.
        A review of 450 stabwounds of the spinal cord.
        S Afr Med J. 1977; 51: 961-964
        • Pal D.
        • Timothy J.
        • Marks P.
        Penetrating spinal injury with wooden fragments causing cauda equina syndrome: case report and literature review.
        Eur Spine J. 2006; 15: 574-577
        • Jaiswal M.
        • Gandhi A.
        • Sharma A.
        • Mittal S.R.
        Spectrum of complex non-missile penetrating spinal injury: a series of four cases with review of literature.
        ResearchGate. 2014; 5: 25-34
        • Borup L.
        • Meehan J.
        • Severson J.
        • Kaufman K.
        On the AJR viewbox: terminal spine of agave plant extracted from patient's spinal cord.
        AJR Am J Roentgenol. 2003; : 1155-1156
        • Okten A.I.
        • Adam M.
        • Gezercan Y.
        Textiloma: a case of foreign body mimicking a spinal mass.
        Eur Spine J. 2006; 15: 626-629
        • Sahin S.
        • Atabey C.
        • Simşek M.
        • Naderi S.
        Spinal textiloma (gossypiboma): a report of three cases misdiagnosed as tumour.
        Balkan Med J. 2013; 30: 422-428
        • Atabey C.
        • Turgut M.
        • Ilica A.T.
        Retained surgical sponge in differential diagnosis of paraspinal soft-tissue mass after posterior spinal surgery: report of eight cases.
        Neurol India. 2009; 57: 320-323
        • Aydogan M.
        • Mirzanli C.
        • Ganiyusufoglu K.
        • Tezer M.
        • Ozturk I.
        A 13-year-old textiloma (gossypiboma) after discectomy for lumbar disc herniation: a case report and review of the literature.
        Spine J. 2007; 7: 618-621
        • Karcnik T.J.
        • Nazarian L.N.
        • Rao V.M.
        • Gibbons G.E.
        Foreign body granuloma simulating solid neoplasm on MR.
        Clin Imaging. 1997; 21: 269-272
        • Kim H.S.
        • Chung T.-S.
        • Suh S.H.
        • Kim S.Y.
        MR imaging findings of paravertebral gossypiboma.
        AJNR Am J Neuroradiol. 2007; 28: 709-713
        • Martinez-del-Campo E.
        • Rangel-Castilla L.
        • Soriano-Baron H.
        • Theodore N.
        Magnetic resonance imaging in lumbar gunshot wounds: an absolute contraindication?.
        Neurosurg Focus. 2014; 37E13
        • Finitsis S.N.
        • Falcone S.
        • Green B.A.
        MR of the spine in the presence of metallic bullet fragments: is the benefit worth the risk?.
        AJNR Am J Neuroradiol. 1999; 20: 354-356
        • Ebner F.
        • Tölly E.
        • Tritthart H.
        Uncommon intraspinal space occupying lesion (foreign-body granuloma) in the lumbosacral region.
        Neuroradiology. 1985; 27: 354-356
        • Levy M.L.
        • et al.
        Use of methylprednisolone as an adjunct in the management of patients with penetrating spinal cord injury: outcome analysis.
        Neurosurgery. 1996; 39: 1141-1149
        • Sidhu G.S.
        • Ghag A.
        • Prokuski V.
        • Vaccaro A.R.
        • Radcliff K.E.
        Civilian gunshot injuries of the spinal cord: a systematic review of the current literature.
        Clin Orthop. 2013; 471: 3945-3955
        • Singh A.
        • Tetreault L.
        • Kalsi-Ryan S.
        • et al.
        Global prevalence and incidence of traumatic spinal cord injury.
        Clin Epidemiol. 2014; 6: 309-331
        • National Spinal Cord Injury Statistical Center
        Spinal cord injury facts and figures at a glance.
        J Spinal Cord Med. 2012; 35