Navigating Complex Spinal Cord Injuries: The Dual Challenge of Retained Foreign Bodies and Lead Toxicity Diagnosis
Authors: Amjad Muhammad Hassaan , Badar Uddin Ujjan  , Fakhar Hayat  , Faizuddin  , Niaz Ahmad Khan  , Mian Iftikhar Ul Haq  
Published: August 2024

Background: Spinal cord injuries (SCIs) present formidable challenges in the realm of medical diagnosis and treatment. These injuries can result in profound and permanent disabilities, necessitating a multifaceted approach to care. Among the complexities associated with SCIs, the presence of retained foreign bodies (RFBs) and the potential for lead toxicity add layers of diagnostic and therapeutic difficulty. RFBs, often remnants of traumatic events such as gunshot wounds or surgical procedures, can complicate the clinical picture, leading to chronic pain, infections, and neurological deficits. Concurrently, lead toxicity, although rare, can arise from retained metallic objects, posing systemic health risks that require vigilant monitoring and intervention.
Objective: The main objective of this study was to investigate the complexities of spinal cord injuries compounded by retained foreign bodies and the diagnostic challenges posed by lead toxicity.
Methods: This retrospective observational study was conducted at Lahore General Hospital from 2021 to 2023. Data were collected from 78 patients with spinal cord injuries suspected of lead toxicity. Patient data, including demographics, medical history, presenting symptoms, imaging findings, laboratory results, and treatment outcomes, were systematically collected from electronic medical records. Diagnostic modalities such as magnetic resonance imaging (MRI), computed tomography (CT), and X-ray imaging were utilized to identify the presence and location of RFBs. Blood lead levels and other relevant biochemical markers were assessed to evaluate lead toxicity. Treatment strategies varied depending on the nature and severity of the injuries, encompassing surgical removal of RFBs, chelation therapy for lead toxicity, and rehabilitation interventions to address functional deficits. Follow-up assessments were conducted to evaluate the efficacy of treatment and monitor for any complications or recurrence of symptoms. Data were analyzed using SPSS version 25, with subgroup analyses performed to explore associations between variables.
Results: The study included 78 patients with spinal cord injuries, with a mean age of 42.01 ± 9.6 years. Among these patients, 47 (60%) were male and 31 (40%) were female. Gunshot wounds were the most common cause, affecting 35 patients (45%), followed by motor vehicle accidents in 23 patients (30%), and falls in 20 patients (25%). Retained foreign bodies were present in 43 patients (55%), with 9 of these (12%) exhibiting lead toxicity. Significant associations were found between the size of retained foreign bodies and the severity of neurological deficits (p < 0.001). Patients who underwent RFB removal showed significantly greater improvement in neurological function compared to those who did not (p = 0.003). Pain relief was significantly better in patients without lead toxicity compared to those with lead toxicity (p = 0.012). Lead toxicity was associated with delayed recovery (p = 0.027), and higher blood lead levels were linked to poorer neurological improvement (p = 0.019). Age was significantly associated with the likelihood of RFB presence (p = 0.045), and follow-up duration differed significantly between patients with and without lead toxicity (p = 0.036).
Conclusion: Spinal cord injuries (SCIs) complicated by retained foreign bodies (RFBs) and lead toxicity present significant diagnostic and therapeutic challenges. The integration of advanced imaging modalities and vigilant monitoring for toxicological complications is essential for effective management. Surgical removal of RFBs and chelation therapy for lead toxicity have shown promising outcomes in improving neurological function and alleviating symptoms.