Near miss for big red: a unique case of penetrating glass injury of the thoracic spine and posterior mediastinum

Abstract

INTRODUCTION: A 42-year-old female with no significant comorbidities presented to our care with a penetrating glass injury to her mid-thoracic spine after falling backwards onto a table. CASE PRESENTATION: A large fragment of glass was protruding from her spine, and multi-planar computed tomography imaging revealed protrusion through the thoracic spinal vertebrae with the glass shards located 2 mm from the aortic lumen. The management of this patient posed several challenges, including initial care of the patient, evaluation of potentially affected structures and the appropriate sequence of therapeutic interventions. After multidisciplinary discussion, our trauma, thoracic and neurosurgical teams formulated a diagnostic workup and two-step surgical approach to address her injuries. DISCUSSION: Here we present the approach used by our team to successfully manage this type of injury. We hope this case report represents a platform for future discussion on best management approaches in patients presenting with the low-velocity penetrating thoracic, spinal and posterior mediastinal trauma.