Delayed spinal endoscopy-assisted posterolateral removal of deep retained glass fragments at the pediatric cervicothoracic junction after emergency debridement: a case report

Abstract Background Deep retained glass foreign bodies at the pediatric cervicothoracic junction are rare and technically challenging. This region is close to the neural foramen, nerve roots, pleural apex, deep vessels, and osseous structures. During the contaminated emergency phase, aggressive exploration in pursuit of complete radiological clearance may increase the risk of iatrogenic injury. A staged strategy may therefore be considered when selected high-risk fragments cannot be safely removed during initial debridement. Case presentation We report the case of a 13-year-old boy who sustained an open glass injury to the left side of the neck in a traffic accident. Initial computed tomography (CT) showed multiple hyperdense foreign bodies in the left posterolateral neck and cervicothoracic soft tissues. The deeper fragments were adjacent to the left second costotransverse region and in close proximity to the left T1–T2 intervertebral foramen. Cervical computed tomography angiography (CTA) and venography (CTV) identified no major vascular injury. Emergency debridement and exploration were performed through the original wounds, and several accessible large glass fragments were removed. Deep fragments that could not be safely accessed were not pursued by blind or extended exploration. Three months later, follow-up CT showed persistent, relatively large retained glass fragments adjacent to the left second costotransverse region. After detailed imaging assessment and preoperative localization, delayed removal was performed using a Delta spinal endoscopic system through a posterolateral working channel established via the left T1–T2 intertransverse space. Two large deep glass fragments and multiple irregular fragments were removed under magnified endoscopic visualization. Postoperative CT confirmed removal of the target deep foreign bodies, with only scattered tiny hyperdense foci remaining. The child recovered uneventfully, with good wound healing and normal sensation and muscle strength in both upper limbs. Conclusion This case illustrates that, after emergency debridement, delayed Delta spinal endoscopy-assisted posterolateral removal may be considered for selected deeply retained glass fragments at the pediatric cervicothoracic junction when repeat imaging confirms stable localization and a safe working corridor. Small, scattered, asymptomatic residual fragments may be managed with close follow-up.