Screw driver: an unusual cause of cervical spinal cord injury.

Non-missile penetrating spinal injuries are rare. Screw driver injury, more especially to the cervical spine, represents an even rarer subset. To our knowledge, this is the first reported case from West Africa of cervical spinal cord injury from a screw driver. A middle-aged man was stabbed from the back with a screw driver. He presented with right-sided C4 Brown-Sequard syndrome with the impaling object in situ. Cervical spine x-rays showed the screw driver to have gone into the spine between the spinous processes of C4 and C5, traversing the spinal canal and lodged in the anterior part of the C4/5 intervertebral disc space. C4 and C5 laminectomies were performed and the screw driver removed under vision. The object was found to have traversed the right side of the cervical spinal cord. The dural tear was repaired. He had some neurologic improvement initially, but later declined. He died from severe pulmonary complications 2 weeks postinjury. Screw driver represents an unusual cause of non-missile penetrating cervical spinal injury. Its neurological effects and complications of the cord injury lead to significant morbidity and mortality.