Penetrating trauma to the sacrum: a case report and review of the literature

Study design: Case report and review of the literature. Objective: To report a rare location of penetrating traumatic spinal injury and to review the literature. Background: Apart from gunshot wounds, penetrating spinal injuries are rare, and even rarer at the level of the sacrum. Few cases have been reported in the literature, and their management has not been standardised. Case presentation: A 22-year-old man was struck in the lower back with a screwdriver during a fight. He presented to the emergency department with part of the screwdriver still in place and was neurologically intact. A plain radiograph showed the radiopaque shaft embedded in the body of S3. After skin preparation, the screwdriver was removed under local anaesthesia and the entry wound was sutured. The patient received a tetanus booster and intravenous antibiotic prophylaxis. Outcome: The patient was discharged after 24 hours of uneventful observation, and his neurological examination remained normal throughout follow-up. Conclusion: Given the anatomy of the sacrum and our review of the literature, removal of a foreign body retained in the spine without surgical exploration may be considered in the absence of neurological symptoms, cerebrospinal fluid (CSF) leakage, or a foreign body completely buried beneath the skin.