Nail-gun injury of the cervical spine: simple technique for removal of a barbed nail

Case report

Narendra Nathoo M.D., Ph.D., Atom Sarkar M.D., Ph.D., Gandhi Varma M.D., and Ehud Mendel M.D.
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  • Department of Neurosurgery, Ohio State Medical Center, Columbus, Ohio
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Although nail-gun injuries are a common form of penetrating low-velocity injury, impalement with barbed nails has been underreported to date. Barbed nails are designed to resist dislodgment once embedded, and any attempt at removal may splay open the barbs along the path of entry, with the potential for significant soft-tissue and neurovascular injury. A 25-year-old man sustained a nail impalement of the cervical spine from accidental discharge of a nail gun. The patient was noted to be fully conscious with no neurological deficits. Cervical Zone 2 impalement was noted, with only the head of the nail visible. Angiography revealed the nail lying just anterior to the right vertebral artery (VA), with compression of the vessel. Preoperatively, analysis of a similar nail revealed that orientation of the head determined position of the barbs. A deep neck dissection was then performed to the lateral aspect of the C-3 body, using the nail as a guide. Prior to removal, the nail was turned 180° to change the position of the barbs, to prevent injury to the VA. Nail removal was uneventful. The authors present a simple technique for treatment of a nail-gun injury with a barbed nail. Prior to removal, radiographic analysis of the impaled nail must be performed to determine the presence of barbs. If possible, the surgeon should request a similar nail for analysis prior to surgery. Last, the treating surgeon must have knowledge of the barbs' position at all times during nail removal, to prevent damage to critical structures.

Abbreviations used in this paper: DS = digital subtraction; VA = vertebral artery.

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Contributor Notes

Address correspondence to: Ehud Mendel, M.D., Department of Neurosurgery, N1037 Doan Hall, Ohio State University Medical Center, 410 West 10th Avenue, Columbus, Ohio 43210. email: ehud.mendel@osumc.edu.

Please include this information when citing this paper: published online April 1, 2011; DOI: 10.3171/2011.3.SPINE10718.

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