Direct withdrawal of a knife in the lumbar spinal canal in a patient without neurological deficit: case report and review of the literature

Abstract

We concluded that any neurologic deficit in a patient with a stab-wound injury in the spine must mandate surgical exploration and in patients without neurological deficit, direct removal of the stabbing object is a safe and effective method without adding the risks of a surgical exploration.

Through-and-through stab wound of the cervical spinal canal with retained weapon but no neurological repercussions: an exceptionally rare injury and the case for direct withdrawal. Illustrative case

“… 5 , 6 , 13 , 14 , 17 However, in all such cases with the exception of one, 14 patients had to have a normal preoperative neurological examination, and there was no evidence of direct neurovascular compromise by the retained object in any reported case of direct withdrawal. 5 , 6 , 13 , 17 …”

“…Given the rarity of such injuries, there is no consensus or guidelines regarding the optimal management strategy. 1,4,13,[15][16][17] In fact, the literature on this topic is very scarce, consisting largely of small case series and case reports. 1,4,5,13,[16][17][18][19] While many authors tend to resort to open surgical exploration, in order to atraumatically remove the retained foreign body and minimize the risk of secondary neurovascular injury, 1,4,6,15,[18][19][20] a few others have successfully achieved direct foreign body withdrawal, averting the need for more elaborate surgical procedures.…”

“…1,4,13,[15][16][17] In fact, the literature on this topic is very scarce, consisting largely of small case series and case reports. 1,4,5,13,[16][17][18][19] While many authors tend to resort to open surgical exploration, in order to atraumatically remove the retained foreign body and minimize the risk of secondary neurovascular injury, 1,4,6,15,[18][19][20] a few others have successfully achieved direct foreign body withdrawal, averting the need for more elaborate surgical procedures. 5,6,13,14,17 However, in all such cases with the exception of one, 14 patients had to have a normal preoperative neurological examination, and there was no evidence of direct neurovascular compromise by the retained object in any reported case of direct withdrawal.…”

“…1 , 3–5 , 14 While many argue that such patients should undergo immediate surgical intervention, 1 , 15 a more conservative approach can at times be attempted, including direct withdrawal of the retained foreign body, especially in patients with little or no signs of neurological injury. 5 , 13 , 14 , 16 , 17 Irrespective of the method used, removal of a retained foreign body from the spinal canal can be challenging and may lead to further neurological injury. 8 …”

“…1,[3][4][5]14 While many argue that such patients should undergo immediate surgical intervention, 1,15 a more conservative approach can at times be attempted, including direct withdrawal of the retained foreign body, especially in patients with little or no signs of neurological injury. 5,13,14,16,17 Irrespective of the method used, removal of a retained foreign body from the spinal canal can be challenging and may lead to further neurological injury. 8 We report a unique case of through-and-through NMPSI of the cervical spine with a retained ice pick, but no significant neurological or vascular injury, which was successfully managed via direct withdrawal, averting the need for open surgical exploration.…”