An Unusual Stab Wound of the Cervical Spinal Cord

Rubin, Giorgio; Tallman, David; Sagan, Leszek; Melgar, Miguel

doi:10.1097/00007632-200102150-00023

Cited by 48 publications

(48 citation statements)

References 13 publications

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“…The described approaches are various depending on the location of the foreign body, including exploration to the level of lamina, laminectomy to the effected lamina, laminectomy to the upper and lower lamina, lateral exposures and so on. 11,15,16 Various combinations of spinal stab injuries and clinical pictures are drawn in the literature, but a patient with a lodged knife traversing the spinal canal without neurological deficit such as our patient is a rare entity. The only publication we found is by Li et al, 15 which describes a patient with a lodged knife in the thoracic spine without neurological deficit, which was removed by surgical exploration, and the patient remained neurologically intact after removal.…”

Section: Discussionmentioning

confidence: 97%

“…9 Besides the direct injury caused by the stab to the spinal cord itself, other mechanisms of cord damage are also postulated, including insult to vascular supply of the spinal cord, edema, hemorrhage, ischemia of the spinal cord and countercoup contusion. 11 Avoiding secondary injury after spinal stab wound must be an essential part of management. Methylprednisolone has been shown to reduce cellular damage from secondary injury process and show some beneficial effects after blunt spinal injuries; however, data on spinal stab wounds are lacking to date and not recommended.…”

Section: Discussionmentioning

confidence: 99%

“…8,9,11,15 Many of the case reports on spinal stab wound have described surgical exploration for removal of lodged foreign bodies. 8,11,15 But there is no consensus about the technique of removal in the literature. The described approaches are various depending on the location of the foreign body, including exploration to the level of lamina, laminectomy to the effected lamina, laminectomy to the upper and lower lamina, lateral exposures and so on.…”

Section: Discussionmentioning

confidence: 99%

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Direct withdrawal of a knife lodged in the thoracic spinal canal in a patient with normal neurologic examination: is it safe?

Şakar

Doğrul

Niftaliyev

et al. 2016

Spinal Cord Ser Cases

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Stab wound injuries to the spinal cord are rare, although they commonly cause complete or incomplete neurological deficits. Normal neurological examination with a knife traversing the spinal canal is extremely rare. Here we report on a patient with a knife lodged in the thoracic spine with normal neurological examination and describe direct withdrawal of the knife with excellent results that have not been reported to date. A 50-year-old male patient was admitted to the emergency service because of his sustaining a stab wound to thoracic 3-4 level due to a knife traversing the spinal canal and still lodged in the vertebral bodies. His neurological examination was normal. The knife was withdrawn in the operating room under general anesthesia without bleeding or cerebrospinal fluid leakage. After withdrawal neurological examination was normal and control magnetic resonance imaging showed no abnormalities. Surgical exploration is suggested for spinal stab wounds if there is a retained body. Some authors recommend exploration even no foreign body is detected. Incomplete or complete cord injuries deserve surgical exploration, but in a patient with normal neurological examination direct withdrawal can be a safe option. Exploration of the wound surgically may have risks associated with enlarging the incision, muscle dissection, enlarging dural tear and bony removal, which may have long-term adverse effects. The operation team must be ready for urgent exploration. Cerebrospinal fluid leakage, excessive bleeding or any neurological deficit after removal must mandate surgical exploration. Long-term close follow-up of the patient has paramount importance for late complications such as infection and pseudomeningocele development.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Direct withdrawal of a knife lodged in the thoracic spinal canal in a patient with normal neurologic examination: is it safe?

Şakar

Doğrul

Niftaliyev

et al. 2016

Spinal Cord Ser Cases

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“…Complete transection of the cord due to lateral entry stab wound has also been reported. 7 Figure 1 Sagittal T2-weighted image of cervical spine showing swelling of cervical cord and increased signal intensity consistent with acute oedema. The image shows a small linear low signal intensity within the cord at the C4/5 level, indicating haemosiderin at the site of cord injury…”

Section: Discussionmentioning

confidence: 99%

Unusual stab injury of the spinal cord

2004

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Objective: To report an unusual penetrating stab injury of the spinal cord. Design: Case report of a 13-year-old boy who sustained cervical trauma following an accident while playing. Setting: Spinal Cord Injuries Unit, Musgrave Park Hospital, Belfast, UK. Case report: Mechanism of injury was by a spear-like electric fence post entering the neck. Initial neurological examination revealed tetraplegia with C4 sensory level. Magnetic resonance imaging (MRI) of spinal cord demonstrates the penetrating injury. Conclusion:No ligamentous instability was demonstrated. In the absence of this, the penetrating injury by a short blade thrown at speed was felt to be responsible for the subsequent injury and resulting outcome at discharge of C4 American Spinal Injury Association (ASIA) grade D tetraplegia.

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“…Most surgeons advocate immediate exploration of the spinal cord wound when it is clear that a foreign body is present, a CSF leakage persists for several days, or there is progressive neurological deterioration. 1,2,13 On the other hand, Simpson et al 14 demonstrated no benefits from surgical treatment compared to conservative management in patients with penetrating spinal injuries. Based upon the indications for surgical intervention detailed by Lipschitz and Peacock, the patient in this report was treated conservatively.…”

mentioning

confidence: 99%

Brown–Séquard-plus syndrome due to stab injury: a case report

et al. 2005

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Study Design: Case report. Objective: To describe the mechanism of injury in this case and its clinical features. Magnetic resonance (MR) images of hemorrhage in spinal cord injury due to stab wound are discussed. Methods: We describe the case of a 21-year-old woman who was stabbed in the right side of her neck and developed left-sided Brown-Se´quard syndrome plus loss of bilateral proprioceptive sensation. Neither plain radiographs nor computed tomography of the cervical spine demonstrated any foreign bodies or fractures of the cervical spine. T2-weighted cervical MR images confirm spinal cord hemiresection at C5-C6. Results: MR imaging was performed serially at 4 days, 4 weeks, and 8 weeks after trauma. The signal pattern of the spinal cord at the site of injury varied iso, iso, and low on T1-weighted consecutive images. Meanwhile, high signal intensity on T2-weighted images was consistent during the 8 weeks after incidence of trauma. A T2-weighted sagittal image showed a tiny spot of low intensity in the high signal band at the site of penetration, demonstrating hemosiderin formation in the spinal cord. The patient was treated conservatively and, recovered from Frankel grade C to grade D. Conclusion: Spinal cord injuries (SCI) following stab wounds are rare. MR imaging is definitely useful for recording and monitoring the pathology of SCI.

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An Unusual Stab Wound of the Cervical Spinal Cord

Cited by 48 publications

References 13 publications

Direct withdrawal of a knife lodged in the thoracic spinal canal in a patient with normal neurologic examination: is it safe?

Direct withdrawal of a knife lodged in the thoracic spinal canal in a patient with normal neurologic examination: is it safe?

Unusual stab injury of the spinal cord

Brown–Séquard-plus syndrome due to stab injury: a case report

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