Management of non-missile penetrating spinal injury

Wallace, David J.; Sy, Christopher; Peitz, Geoffrey W.; Grandhi, Ramesh

doi:10.1007/s10143-018-01057-1

Cited by 10 publications

(20 citation statements)

References 56 publications

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“…Aufgrund der Rarität der akuten Rückenmarksschädigung durch Messerstichverletzungen existieren keine standardisierten Behandlungsempfehlungen in Deutschland [5]…”

Section: Einführungunclassified

Akuter Querschnitt infolge Messerstichverletzung

2021

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“…Aufgrund der Rarität der akuten Rückenmarksschädigung durch Messerstichverletzungen existieren keine standardisierten Behandlungsempfehlungen in Deutschland [5]…”

Section: Einführungunclassified

Akuter Querschnitt infolge Messerstichverletzung

2021

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“…In the United States, spinal cord injury incidence is 17,700 cases/year, and only 0.8% correspond to nonmissile penetrating injuries. [11] Stabbing injuries are not a frequent cause of traumatic cerebrospinal fluid leak (CSFL), reported to be up to 4% in spine stab wounds. [11] ere are few reports about traumatic CSFL secondary to stab injuries in the lumbar spine.…”

Section: Introductionmentioning

confidence: 99%

“…[11] Stabbing injuries are not a frequent cause of traumatic cerebrospinal fluid leak (CSFL), reported to be up to 4% in spine stab wounds. [11] ere are few reports about traumatic CSFL secondary to stab injuries in the lumbar spine. [11] e severity of neurological compromise in non-missile penetrating injuries is variable.…”

Section: Introductionmentioning

confidence: 99%

“…[11] ere are few reports about traumatic CSFL secondary to stab injuries in the lumbar spine. [11] e severity of neurological compromise in non-missile penetrating injuries is variable. Complete injury is found in 19-38% of patients, and Brown-Séquard Syndrome is observed in 31-55% of them.…”

Section: Introductionmentioning

confidence: 99%

“…Complete injury is found in 19-38% of patients, and Brown-Séquard Syndrome is observed in 31-55% of them. [11] At present, there are only three case reports of spinal stab injury in the absence of neurologic deficit. [1,3,11] Here, we describe an unusual case of lumbar spine stab injury in a young adult with consequent penetrating fracture of the lamina and secondary CSFL with no neurological deficit that required multimodal intervention, including nonsurgical and surgical treatment.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Cerebrospinal fluid leak following penetrating trauma to the spine without neurological deficit: A case report

Ramírez-Ferrer¹,

Abaunza-Camacho²,

Pineda-Martinez³

et al. 2022

Surgical Neurology International

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Background: Posttraumatic spinal cerebrospinal fluid leak (CSFL) without neurological deficit is a rare entity. Historically, the first-line treatment is a nonsurgical approach, which includes Trendelenburg positioning, carbonic anhydrase inhibitor (acetazolamide), and subarachnoid catheter, with a high successful rate of leak correction. However, in some cases, this first-line treatment could fail, being necessary the surgical approach. Case Description: A 23-year-old male with a recent stab wound to his lumbar region, complained of positional headache and fluid outflow through his wound. On physical examination, an active CSFL was detected without evidence of neurologic deficit. Imaging studies showed a CSF collection extending from the right L4 lamina to the subcutaneous tissue. CSF studies revealed bacterial meningitis. The treatment with carbonic anhydrase inhibitors, Trendelenburg position, lumbar subarachnoid catheter, and antibiotics was initiated. Failure of conservative measures prompted a surgical treatment to resolve the CSFL. Intraoperatively, a dura mater defect was identified, and an autologous paravertebral muscle flap was used for water-tight closure of the defect. The patient recovered without further complications and with CSFL resolution. Conclusion: Even though the nonsurgical approach is the first-line of treatment of traumatic CSFL cases, failures can occur. The evidence of a CSF trajectory in imaging studies could be a predictor of treatment failure of the nonsurgical treatment. The surgical treatment as second-line treatment has outstanding results regarding CSFL correction and should be considered when the prediction rate to nonsurgical approach failure is high.

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