{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:48:42Z","timestamp":1785890922406,"version":"3.56.0"},"reference-count":7,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","license":[{"start":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T00:00:00Z","timestamp":1785715200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,8,3]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Penetrating cervical spine injuries caused by nail guns are rare. Associated esophageal injury and dural violation increase the risk of neurological and infectious complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 40-year-old man presented approximately 4 hours after a nail gun injury to the anterior neck. Imaging showed that the nail traversed the C4\u20135 disc space, entered the vertebral body, and violated the spinal canal. He had right-sided weakness with motor strength graded as 4\/5. Anterior cervical exploration was performed approximately 14 hours after presentation. Intraoperatively, a traumatic dural defect with CSF leakage and a 0.5-cm esophageal perforation were identified. The dural defect was covered with gelatin sponge and fibrin glue, and the esophageal perforation was repaired primarily. At 1 year, his motor strength was grade 5\/5 in all extremities. Follow-up MRI showed a small C4 intramedullary T2-hyperintense focus consistent with myelomalacia, without clinical or imaging evidence of delayed infection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>CT-based trajectory assessment is critical in anterior cervical nail gun injury. Controlled anterior exploration can allow safe foreign body removal, dural defect management, esophageal repair, and surveillance for delayed infectious complications.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE26301\">https:\/\/thejns.org\/doi\/10.3171\/CASE26301<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case26301","type":"journal-article","created":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:01:39Z","timestamp":1785888099000},"source":"Crossref","is-referenced-by-count":0,"title":["Nail gun penetrating cervical spine injury at C4\u20135 with spinal canal violation, neurological deficit, and esophageal perforation treated by anterior cervical surgery: illustrative case"],"prefix":"10.3171","volume":"12","author":[{"given":"Chengfei","family":"Peng","sequence":"first","affiliation":[{"name":"Department of Spine Surgery, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, Guangxi, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3779-9397","authenticated-orcid":true,"given":"Zhizhu","family":"Peng","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, Guangxi"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"1","key":"bib1","series-title":"J Neurosurg Spine","first-page":"60","article-title":"Nail-gun injury of the cervical spine: simple technique for removal of a barbed nail","volume":"15","author":"Nathoo","year":"2011","unstructured":"Nathoo NSarkar AVarma GMendel E.Nail-gun injury of the cervical spine: simple technique for removal of a barbed nail. J Neurosurg Spine. 2011;15(1):60-63. doi:10.3171\/2011.3.SPINE10718"},{"key":"bib2","series-title":"World Neurosurg","first-page":"321","article-title":"Nail gun injury of the spine: case report and review of the literature","volume":"132","author":"Xiang","year":"2019","unstructured":"Xiang GWu ZZhao XZhao XFeng Y.Nail gun injury of the spine: case report and review of the literature. World Neurosurg. 2019;132:321-325. doi:10.1016\/j.wneu.2019.08.125"},{"issue":"1","key":"bib3","series-title":"Trauma Surg Acute Care Open","first-page":"e001619","article-title":"Penetrating neck trauma: a comprehensive review","volume":"10","author":"Loss","year":"2025","unstructured":"Loss LHenry RWhite APenetrating neck trauma: a comprehensive review. Trauma Surg Acute Care Open. 2025;10(1):e001619. doi:10.1136\/tsaco-2024-001619"},{"issue":"6","key":"bib4","series-title":"Dis Esophagus","first-page":"doae007","article-title":"Current aspects in the management of esophageal trauma: a systematic review and proportional meta-analysis","volume":"37","author":"Papaconstantinou","year":"2024","unstructured":"Papaconstantinou DKapetanakis EIMylonakis ACurrent aspects in the management of esophageal trauma: a systematic review and proportional meta-analysis. Dis Esophagus. 2024;37(6):doae007. doi:10.1093\/dote\/doae007"},{"issue":"3","key":"bib5","series-title":"J Neurosurg Spine","first-page":"285","article-title":"Esophageal perforation after anterior cervical spine surgery: a systematic review of the literature","volume":"25","author":"Halani","year":"2016","unstructured":"Halani SHBaum GRRiley JPEsophageal perforation after anterior cervical spine surgery: a systematic review of the literature. J Neurosurg Spine. 2016;25(3):285-291. doi:10.3171\/2016.1.SPINE15898"},{"issue":"3","key":"bib6","series-title":"Can J Neurol Sci","first-page":"203","article-title":"Nail-gun injury through the spinal canal","volume":"42","author":"Bigder","year":"2015","unstructured":"Bigder MZeiler FBerrington N.Nail-gun injury through the spinal canal. Can J Neurol Sci. 2015;42(3):203-204. doi:10.1017\/cjn.2015.17"},{"issue":"3","key":"bib7","series-title":"J Trauma Inj","first-page":"223","article-title":"Endovascular treatment of penetrating nail gun injury of the cervical spine and vertebral artery: a case report","volume":"35","author":"Christodoulides","year":"2022","unstructured":"Christodoulides AMitchell SBohnstedt BN.Endovascular treatment of penetrating nail gun injury of the cervical spine and vertebral artery: a case report. J Trauma Inj. 2022;35(3):223-227. doi:10.20408\/jti.2021.0082"}],"container-title":["Journal of Neurosurgery: Case Lessons"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/12\/5\/article-CASE26301.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/12\/5\/article-CASE26301.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/12\/5\/article-CASE26301.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:01:40Z","timestamp":1785888100000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/12\/5\/article-CASE26301.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,3]]},"references-count":7,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.3171\/case26301","relation":{},"ISSN":["2694-1902"],"issn-type":[{"value":"2694-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,3]]}}}