Nail gun penetrating cervical spine injury at C4-5 with spinal canal violation, neurological deficit, and esophageal perforation treated by anterior cervical surgery: illustrative case.

Authors

Chengfei Peng, Zhizhu Peng

Published in

Journal of neurosurgery. Case lessons. Volume 12. Issue 5. Aug 03, 2026. Epub Aug 03, 2026.

Abstract

Penetrating cervical spine injuries caused by nail guns are rare. Associated esophageal injury and dural violation increase the risk of neurological and infectious complications.
A 40-year-old man presented approximately 4 hours after a nail gun injury to the anterior neck. Imaging showed that the nail traversed the C4-5 disc space, entered the vertebral body, and violated the spinal canal. He had right-sided weakness with motor strength graded as 4/5. Anterior cervical exploration was performed approximately 14 hours after presentation. Intraoperatively, a traumatic dural defect with CSF leakage and a 0.5-cm esophageal perforation were identified. The dural defect was covered with gelatin sponge and fibrin glue, and the esophageal perforation was repaired primarily. At 1 year, his motor strength was grade 5/5 in all extremities. Follow-up MRI showed a small C4 intramedullary T2-hyperintense focus consistent with myelomalacia, without clinical or imaging evidence of delayed infection.
CT-based trajectory assessment is critical in anterior cervical nail gun injury. Controlled anterior exploration can allow safe foreign body removal, dural defect management, esophageal repair, and surveillance for delayed infectious complications. https://thejns.org/doi/10.3171/CASE26301.

PMID:
42546348
Bibliographic data and abstract were imported from PubMed on 04 Aug 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.