Penetrating thoracic spinal cord injury with ice pick extending into the aorta. A technical note and review of the literature

Abstract

Background:Penetrating spinal cord injuries pose a great challenge to both patients and the treating physicians. Although the overall incidence of penetrating spinal cord injury is the highest in the military, the ubiquity of guns in our society continues to make penetrating spinal cord injury prevalent in the civilian population. These types of injuries are particularly complicated because, beyond the trauma to the neural elements and supporting structures, other organs can be affected and a team approach is required for successful treatment.Case Description:In this report, the authors present a unique case of an ice pick penetrating posteriorly through the spinal canal into the aorta. The described surgical management involved careful consideration and planning to prevent worsening vascular and neurological compromise. Among the challenges faced are neurological compromise, vascular injury, spinal instability, and cerebrospinal fluid leak.Conclusion:To the author’s knowledge, this challenging case represents the first description of a successful removal of a penetrating thoracic spinal foreign body that terminated within the lumen of the thoracic aorta.

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

“…Regarding prevention of complications, broad spectrum antibiotics were continued for up to 72 h post-operatively, until the surgical wound status was checked [12]. We did not use methylprednisolone as it is shown to have adverse effects in patients with penetrating injury to the spinal cord [13].…”

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.…”

“…The thoracic spine represents the most affected part, followed by the cervical and lumbar spine [9]. The complications due to penetrating thoracic spine injuries can extend beyond the trauma to involve neural elements, supporting structures, and other organs, such as neurological compromise, vascular damage, spine instability, and cerebrospinal fluid (CSF) leakage [6]. Hemothorax is also a significant complication associated with spine injuries and may occur due to damage to pulmonary parenchyma, heart, intercostal vessels, and major intrathoracic vessels [3].…”