Penetrating spine injury bisecting thoracic spinal canal with no significant neurological deficits—The midline cord syndrome

Abstract

Introduction In India, the incidence of penetrating spine injury (PSI) is increasing because of the increased use of advanced ballistics (missile PSI) among military personnel and sophisticated tools and construction instruments like nail-guns or drills (non-missile PSI) among civilians. These injuries are associated with a risk of neurological damage, central nervous system infections, vascular injury, dural tear followed by CSF leakage, and spinal instability. Case presentation A 35-year-old male presented with a non-missile PSI with retained iron nail bisecting his dorsal spinal cord, without any motor deficits. Patient presented with only left lower limb proprioceptive loss and L1-L3 paresthesia. Nail removal was done on emergent basis without any further neurological damage. Discussion To the best of our knowledge, this presentation of a non-missile PSI and has not been previously reported. The specific clinical presentation of this distinct type of injury to the midline structures of the spinal cord is hence named "midline cord syndrome".

Penetrating thoracic spine injury causing haemothorax

“…Thoracic spine penetrating injuries cause complications such as myelopathy, central nervous system infections, CSF leak following dural tear, spinal instability, and delayed neurological deficits [6,7]. Of these complications, our patient had CSF leakage with partial neurological compromise.…”

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

“…Three patients underwent open surgical management with laminectomy. 5 , 10 , 11 One patient had the RFB removed through a minimally invasive tubular retractor without laminectomy. 4 One patient had the RFB directly withdrawn at the beginning of the procedure, and then the entry wound was opened, debrided, and exposed down to the lamina.…”

“…3,6,13 Incomplete SCI, usually Brown-Sequard syndrome, is the most common presentation, but between 20% and 30% present with complete SCI. 3,6,7,11,13 In the largest series of spinal cord stab injuries recorded to date, with 450 patients and published by Peacock et al 2 in 1977, 64% of the injuries were thoracic. Among this group of thoracic injuries, 24% were complete and 76% were incomplete injuries.…”

“…Some authors advocate for a low threshold for surgical exploration in NMPSCI with laminectomy to ensure decompression of the spinal cord, debridement of any foreign material, direct repair of any cerebrospinal fluid leak, and irrigation of the wound. [4][5][6][9][10][11][12] However, 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.…”

Role of Whole-Body Computed Tomography Scan to Avoid Missed Foreign Body in Patients with Multiple Stab Injury: A Rare Case of Retained Impaled Knife Blade with Intact Neurology

“… 4 5 The most common cause of NMPSI is an assault with a knife and it involves the thoracic spine in a majority of cases. 1 4 5 6 7 8 9 10 11 NMPSI with impaled object occurs when the assailant finds it difficult to remove the object or when it breaks at the handle.…”