Direct withdrawal of a retained foreign body bisecting the thoracic spinal canal in a neurologically intact pediatric patient: illustrative case.

Background: Nonmissile penetrating spinal cord injury (NMPSCI) with a retained foreign body (RFB) is rare and usually results in permanent neurological deficits. In extremely rare cases, patients can present without significant neurological deficits despite an RFB that traverses the spinal canal. Given the rarity of these cases, a consensus has not yet been reached on optimal management. In a patient with an RFB and a neurologically normal clinical examination, the risk of open surgical exploration may outweigh the benefit and direct withdrawal may be a better option.

Observations: A 10-year-old female suffered an NMPSCI to the thoracic spine with an RFB that bisected the spinal canal but remained neurologically intact. Direct withdrawal of the RFB was chosen instead of open surgical exploration, leading to an excellent clinical outcome. The literature was reviewed to find other examples of thoracic NMPSCI with RFB and neurologically normal examinations. Management strategies were compared.

Lessons: For NMPSCI with RFB and without significant neurological deficits, direct withdrawal is a viable and possibly the best treatment option. The use of fast-acting anesthesia without intubation minimizes patient manipulation, speeds up recovery, and allows early assessment of neurological status after removal.