Non missile penetrating spinal injury

Yoon, Joseph; Efendy, Johnny; Szkandera, Bartosz; Redmond, Michael

doi:10.1016/j.jocn.2019.06.018

Cited by 4 publications

(17 citation statements)

References 28 publications

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“… 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 …”

Section: Discussionmentioning

confidence: 98%

“… 4 , 6–8 , 10 , 11 Visceral and vascular injuries are also commonly associated with NMPSIs. 5 , 7 , 12 Specifically, in the cervical region, there is a high risk of injury to the carotid and vertebral arteries 8 , 12 and the airway. 3 , 7 While knives remain the most common weapon used in NMPSIs, bicycle spokes, screwdrivers, axes, and other sharp objects have also been occasionally used.…”

Section: Discussionmentioning

confidence: 99%

“… 4 , 6–8 , 10 , 11 In addition to neurological injury, NMPSIs can also result in visceral and vascular injuries, especially the vertebral artery in penetrating neck trauma. 3 , 5 , 7 , 12 , 13 …”

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confidence: 99%

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confidence: 99%

“…Nonmissile penetrating spinal injuries (NMPSIs) are uncommon, representing only 0.3%-2.1% of all spinal injuries in the Western population, [1][2][3][4][5] and predominantly affect young men. 3,[5][6][7][8] The majority of such injuries are sustained posteriorly and aggressors generally aim for the neck or chest. 3,7,9 Given the protective effect of spinal bony structures, neurological injury is rare, with a Brown-S equard syndrome being the most common mode of presentation in neurologically impaired patients.…”

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confidence: 99%

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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

Parsons

Fluss

Willis

et al. 2022

Journal of Neurosurgery: Case Lessons

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BACKGROUND Nonmissile penetrating spinal injuries are rare and potentially debilitating. Such injuries can sometimes be complicated by the retention of a foreign body, which is usually part of the assailant’s weapon, making their management even more problematic. OBSERVATIONS We present a unique case of stab wound to the neck with a retained ice pick, traversing the spinal canal from one intervertebral foramen to the other, yet with no ensuing neurological damage to the patient. After carefully analyzing the weapon’s trajectory on computed tomography and ruling out vertebral artery injury via catheter angiography, the ice pick was successfully withdrawn under general anesthesia and intraoperative neurophysiological monitoring, averting the need for a more invasive surgical procedure. LESSONS Stab wounds of the spinal canal with a retained foreign body can occasionally be managed by direct withdrawal. Whether this simple technique is a safe alternative to open surgical exploration should be determined on a case-by-case basis after careful review of spinal and vascular imaging. The absence of significant neurological or vascular injury is an absolute prerequisite for attempting direct withdrawal. Moreover, preparations should be made for possible conversion to open surgical exploration in the rare event of active hemorrhage, expanding hematoma, or acute neurological deterioration.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

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

Parsons

Fluss

Willis

et al. 2022

Journal of Neurosurgery: Case Lessons

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Thoracic spine stab injury with a retained knife

Ingram-Walpole,

Shah,

Almerie

et al. 2024

BMJ Case Rep

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A female was admitted to a Major Trauma Centre with an isolated thoracic spine stab injury involving a retained knife. The patient was haemodynamically stable with an unremarkable peripheral neurological examination. A CT scan with three-dimensional image reconstruction showed the knife blade lodged in the T11 vertebra with its tip close to the spinal cord, aorta and inferior vena cava. A multidisciplinary trauma team, including anaesthetists, vascular, neurosurgeons and general surgeons, agreed on the treatment strategy. The lodged knife was safely withdrawn in the operating theatre with the patient in a prone position under sedation and local anaesthesia. Following the procedure, neurological examination remained normal, and an MRI scan revealed no spinal cord injury. We discuss the management of penetrating spinal injuries, the importance of detailed preoperative imaging, timely multidisciplinary input and how to safely remove a knife when a prone position prevents standard airway management.

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Direct withdrawal of a retained foreign body bisecting the thoracic spinal canal in a neurologically intact pediatric patient: illustrative case

Peters

VanHorn²,

Karimian

et al. 2023

Journal of Neurosurgery: Case Lessons

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BACKGROUND Nonmissile penetrating spinal cord injury (NMPSCI) with a retained foreign body (RFB) is rare and usually results in permanent neurological deficits. In extremely rare cases, patients can present without significant neurological deficits despite an RFB that traverses the spinal canal. Given the rarity of these cases, a consensus has not yet been reached on optimal management. In a patient with an RFB and a neurologically normal clinical examination, the risk of open surgical exploration may outweigh the benefit and direct withdrawal may be a better option. OBSERVATIONS A 10-year-old female suffered an NMPSCI to the thoracic spine with an RFB that bisected the spinal canal but remained neurologically intact. Direct withdrawal of the RFB was chosen instead of open surgical exploration, leading to an excellent clinical outcome. The literature was reviewed to find other examples of thoracic NMPSCI with RFB and neurologically normal examinations. Management strategies were compared. LESSONS For NMPSCI with RFB and without significant neurological deficits, direct withdrawal is a viable and possibly the best treatment option. The use of fast-acting anesthesia without intubation minimizes patient manipulation, speeds up recovery, and allows early assessment of neurological status after removal.

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Non missile penetrating spinal injury

Cited by 4 publications

References 28 publications

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

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

Thoracic spine stab injury with a retained knife

Direct withdrawal of a retained foreign body bisecting the thoracic spinal canal in a neurologically intact pediatric patient: illustrative case

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