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Nail-gun Injury through the Spinal Canal

A 27-year-old man presented to our trauma centre after having sustained an accidental nail-gun injury resulting in a penetrating wound to the left lateral aspect of his neck. He arrived to hospital via ambulance with cervical spinal precautions in place. Upon arrival he was found to be hemodynamically stable and neurologically intact. He described an initial transient ‘electric’ like sensation in his arms and legs at the time of the accident, which promptly resolved and was no longer present at the time of arrival. A computed tomogram (CT) angiogram was performed to assess the relationship between the nail, vertebral, and carotid arteries as well as the spinal canal. The nail measured 3.5 cm and was noted to pass posteriorly, in close proximity to the vertebral artery, through the left C1-C2 neural foramen (Figure 1A, Figure 2B), coming to rest with the tip of the nail in the centre of the spinal canal (Figure 1B, Figure 2A). Based on the CT, there did not appear to be any barbs on the nail. Remarkably, there was no evidence of injury to the vertebral arteries on imaging and the patient remained neurologically intact. Following initial imaging, the patient was transferred to the operating room and the nail was removed without complications by simply pulling along the trajectory of the nail. A CT angiogram was repeated immediately following removal and showed no injury to the major vessels, hemorrhage or pseudomeningocele (Figure 3). At two-month follow-up, the patient was asymptomatic with no signs of complication or infection.