Acute neurologic deterioration after surgical treatment for thoracic spinal stenosis

Single-level bilateral facet joint hypertrophy causing thoracic spinal canal stenosis

“…If the blade is directed upward or downward from the arch of the atlas, the blade can cause direct injury to the spinal cord. 5,9 In our patient, the SCI resulted from a direct knife injury. The motor deficit was due to the disruption of the left corticospinal tracts below the level of decussation in the lower medulla.…”

“…In a spinal stab wound, the blade is guided along the gutter between the spinous and transverse processes of the vertebrae; this guides the weapon to one side of the spinal cord only. 5 Therefore, most patients present with an incomplete SCI and the BrownSequard syndrome. 2,5,7,8 At the craniocervical junction, the knife blade is usually deflected by the occipital bone and slides on the undersurface of the occiput.…”

“…5 Therefore, most patients present with an incomplete SCI and the BrownSequard syndrome. 2,5,7,8 At the craniocervical junction, the knife blade is usually deflected by the occipital bone and slides on the undersurface of the occiput. If the blade strikes the occipitoatlantal articular mass, the vertebral artery or vein can be damaged.…”

“…[1][2][3][4][5] Here we describe a patient with an unusual case of thoracic myelopathy caused by bilateral facet joint hypertrophy, occurring in isolation at the thoracic T10-11 level.…”

“…1-3 Reports of stab injuries at the craniocervical junction are rare. [4][5][6] Because of the anatomy of this area, the penetrating weapon is deflected by the occipital squama into the atlanto-occipital or atlantoaxial interspace in the craniocervical junction. If the blade penetrates the dura mater, cerebrospinal fluid (CSF) tracks through the dural opening, resulting in a pseudomeningocele.…”