Senior Scholars Program

Title

Intraspinal penetrating stab injury to the middle thoracic spinal cord with no neurologic deficit

UMMS Affiliation

Department of Orthopedics and Physical Rehabilitation

Date

5-2012

Document Type

Article

Medical Subject Headings

Adolescent; Decompression, Surgical; Dura Mater; Humans; Laminectomy; Male; Nervous System Diseases; Postoperative Complications; Spinal Cord Injuries; Spine; Thoracic Vertebrae; Time Factors; Treatment Outcome; Wounds, Stab

Disciplines

Life Sciences | Medicine and Health Sciences

Abstract

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.

Rights and Permissions

Citation: Orthopedics. 2012 May;35(5):e770-3. doi: 10.3928/01477447-20120426-40. Link to article on publisher's site

Related Resources

Link to Article in PubMed

PubMed ID

22588426