Penetrating spinal injury: reports of two cases (original) (raw)
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Neurosurgery Quarterly, 2013
Objective: Injury to the spine and spinal cord by knife and similar sharp objects is rarely seen and constitutes 1.5% of all spinal injuries. In developing countries with low socioeconomic status it is occasionally seen in accidents, but mostly in assaulted cases involving the use of knife. The aim of this study is to analyze our cases and review the literature.
Penetrating Stab Injury to the Thoracic Spinal Cord: A Case Report
Indian Journal of Neurotrauma, 2015
Stab injuries to the spinal cord due to knife are rare. Usually the knife slips into the interlaminar space to injure the cord incompletely. We report a 24-year-old man who was stabbed by robber in the thoracic region. He presented with the Brown-Séquard plus syndrome. Knife penetrated the lamina, driving the bony chip into extradural space injuring the dura and cord. The patient was subjected to laminectomy and duraplasty with fascial graft. He showed good improvement and has joined his occupation.
Penetrating Stab Wounds of the Spine: Two Cases and Review of the Literature
International Blood Research & Reviews
Penetrating wounds of the spine caused by edged weapons are on the increase due to the growing insecurity, violence, availability and accessibility of these weapons, which are generally objects of everyday use (knife, axe, machete, screwdriver, bicycle spoke, scissors, garden fork, sickle and sharpened broom handle, etc.). These objects may be the cause of penetrating wounds responsible for neurological deficits with breaches of the dura mater, or they may be without neurological deficits due to the level of the weapon in the spine. We present two clinical cases of patients with penetrating knife wounds of the spine. One at cervical level with pneumorrhagic emphysema, spinal cord compression and pneunemoencephaly, with neurological deficit who had a surgical intervention followed by physiotherapy and a progressive recovery, the other with a penetrating wound at L5 crossing the blade to the vertebral body without neurological deficit in whom the knife was extracted at the emergency d...
Intraspinal Penetrating Stab Injury to the Middle Thoracic Spinal Cord With No Neurologic Deficit
Orthopedics, 2012
The annual incidence of traumatic spinal cord injury worldwide is estimated to be 35 patients per million. Nonmissile penetrating spinal injuries most commonly occur in the thoracic region, and the majority has neurologic deficits on admission. The management of patients who lack neurologic deficits is controversial due to the risk of neurologic status alteration intraoperatively. However, failure to intervene increases the risk of infection, delayed onset of neurologic deficits, and worsening functional outcome. A 17-year-old boy presented with an intradural T7-T8 knife penetration injury to the spinal cord with no neurologic deficit. Rapid surgical intervention was critical because the knife was lodged between the 2 hemispheres of the spinal cord. The patient was intubated in the lateral position, transferred to the prone position on a Jackson table, and underwent surgical decompression with laminectomy 1 level above and below the injury site, removal of the knife blade in the original path of trajectory, and repair of the dural tear with a collagen matrix. The patient sustained no neurologic sequelae from the penetrating knife injury. He was able to ambulate at discharge and had no complications. To our knowledge, this is the only report of a patient with intradural spinal cord penetration by a foreign object (knife blade) presenting with a normal neurologic preoperative examination that persisted throughout the course of postoperative care.
Journal of Injury and Violence Research, 2013
Penetrating spinal cord injuries (SCIs) are an uncommon injury and not reported very frequently. SCIs cause sensory, motor and genitourinary system problems or a combination of sensorimotor dysfunctions. These are among the most debilitating kinds of disorders and negatively affect quality of life, not only for the patient, but also for their family members. Therefore, the present study aims to evaluate complete or incomplete SCIs and the course of the injury and the prognosis for SCIs caused by stab wounds. This case-series design study was performed on 57 patients attending the emergency department of Taleqani Trauma Center (Kermanshah, Iran) due to SCIs caused by violent encounters involving sharp objects such as a knife, dagger, whittle and Bowie-knife between 1999 and 2011. An assessment of sensory and motor functions was performed as part of the neurological examination on admission, and during the treatment, using the Frankel Classification grading system, and the results were recorded. The average age of patients was 27 years (SD= 7.9, Range=17 to 46 years). The results of the study showed a proportion of cervical, thoracic and lumbar injuries of 23 (40%), 24 (42%) and 10 (18%), respectively. There was no case of cerebrospinal fluid leakage (CSF) or infection at the wound site in the subjects. Regarding the extent of the SCI, the combined neurological assessment showed that several patients (43%) had a complete SCI with no sensory and motor functions in the sacral segments and the segments below the site of injury. In 32 patients (57%) incomplete injuries were observed; i.e. they showed only some degrees of sensory-motor functions that were below the neurological level. Both complete and incomplete SCIs are of great importance because the prognosis of SCI is directly associated with the location and extent of injury. It should be considered that partial recovery from SCIs is possible in few cases of complete injuries. Therefore, all the patients should be treated carefully and seriously.
Stab injury of the thoracic spinal cord: case report
Turkish neurosurgery, 2008
Stab injuries of the spinal cord are rare. We report a case of a 22-year-old male who was hospitalized because of a spinal cord injury resulting from a stab wound in the posterior thoracolumbar area. On admission, the patient had 2/5 muscle strength of the right leg (monoparesis) and hypoesthesia below the L1 level. Radiological investigation revealed the retained tip of a knife that penetrated the spinal canal at the T12 level. An urgent right T12 hemilaminotomy was performed and retained knife fragment was removed. Six months after operation, the motor deficit had completely improved although hypoesthesia was still present. Surgery should be considered as the first-line treatment in cases of incomplete injuries of the spinal cord with retained metallic object.
Delayed presentation of spinal stab wound: case report and review of the literature
Journal of Emergency Medicine, 2000
e Abstract-Stab wounds to the spinal cord are relatively uncommon in North America, but even rarer is the presentation of such an injury in a delayed fashion. We report a case of a 31-year-old male who presented with neurologic deficit 4 weeks after a stab wound injury to the spine. Because of worsening neurologic deficit, the retained knife fragment was operatively removed, and the patient had an uneventful recovery. The management of such an injury is discussed, with a review of the literature.
Stab Injury of the Spinal Cord Surgically Treated
Journal of Spinal Disorders, 2001
The authors report a case of thoracic spinal cord stab injury with neurologic impairment that was treated surgically after injury. A literature review and case analysis indicate that surgical extraction of foreign bodies retained within the spinal canal is indicated to avoid infection, delayed myelopathy, and neurologic loss. The amount of motor and functional recovery for incomplete injuries after spinal cord stab wound can be strikingly good despite pathologic changes to severely damaged areas, and removal of retained intraspinal metallic fragment can improve this neurologic outcome. Open removal of the knife seems preferable to avoid bleeding and infection.
Thoracic Spinal Cord Stab Injury: A Case Report and Literature Review
Open Journal of Modern Neurosurgery, 2015
Thoracic spinal cord stab injuries are rare lesions. A 17-year-old boy was stabbed on his back by his classmate when he bent forward to pick up his cloth from the ground. On admission, he presented with: complete paraplegia with muscle strength of zero on all muscle groups, complete anesthesia from dermatome 10 and below, acute urinary retention, and a four-centimeter wound on the thoracolumbar region from which cerebrospinal fluid mixed with blood was oozing out. A high-dose methylprednisolone protocol was started (30 mg/kg in one hour and then 5.4 mg/kg over 23 hours) an indwelling urinary catheter placed and sterile dressing of the wound done. Antibiotics and analgesics were also administered. The computed tomography scanning revealed a spinal cord transection at T10-T11 level with incarceration of the broken knife blade. An emergency thoracic laminectomy was performed. Removal of the broken knife blade revealed complete spinal cord transection with a compressive hematoma within the spinal cord which was removed by smooth suction. The spinal dura was sutured and the wound closed in many layers. On day 14 after surgery, sensitivity was recovered with 3 on 5 muscle strength in both lower limbs except for both feet where motor function remained null. Urinary retention and fecal incontinence persisted. The patient was discharged from our service for a rehabilitation center. At 32-month follow-up, neurological examination was unchanged although patient noticed a slight improvement of sphincter disturbances.
Spinal cord stab injuries (SCSI) are rare traumatic lesions when compared to injuries caused by road traffic accidents, sport activities and guns. We report a case of a 31-year-old male who was hospitalized because of being stabbed on the face and the blade penetrated the cervical spine. This was a serious physical violence between two men fighting over a woman. On admission, the patient had left hemiplegia with loss of reflexes and loss of sensation. All cranial nerves were intact, the heart sounds were normal though the patient was unable to shrug his left shoulder. The knife in our patient was very close to the vertebral arteries and the Circle of Willis. However, the long knife was gently removed and no significant bleeding or leakage of the cerebrospinal fluid occurred. The patient was put on antibiotics to avoid infections. The initial management of SCI is crucial for protecting undamaged spinal cord from secondary effects and Surgery should be considered as the first-line treatment in cases of incomplete injuries of the spinal cord with retained metallic object. In spite of scientific progresses, it is still not possible yet to repair a damaged spinal cord.