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Bilateral multiple cervical root avulsions without skeletal or ligamentous damage resulting from blast injury: case
John David Morenski1, Anthony M Avellino, J Paul Elliott
1Division of Neurosurgery, University of Missouri-Columbia, Columbia, Missouri 65212, USA. doctorx@missouri.edu
Objective And Importance:
We describe a unique case of multiple bilateral cervical root injuries without ligamentous or bony injury secondary to a sandblast accident.
Clinical Presentation:
A 19-year-old man sustained a sandblast injury to his face, neck, chest, and upper extremities, with immediate loss of motor and sensory function occurring in both of his upper extremities. Cervical spine x-rays, computed tomography, and magnetic resonance imaging demonstrated no fracture, soft tissue abnormality, or malalignment. The restriction of deficits to the patient's upper extremities suggested a central cervical spinal cord injury, bilateral brachial injuries, or a conversion disorder.
Intervention:
Cervical computed tomographic myelography revealed multiple bilateral nerve root injuries.
Conclusion:
This case report is unique in the literature in that it describes a patient with multiple cervical nerve root injuries secondary to sandblast injury without ligamentous or bony injury. Although magnetic resonance imaging remains the diagnostic modality of choice in patients with acute spinal cord injury, it is deficient in demonstrating cervical root injury in the acute setting. In this setting, computed tomographic myelography is superior.