An unusual stab wound of the cervical spinal cord - A case report

Study Design: A rare case of a laterally directed stab wound injury of the cervical spinal cord is reported. Objective: To describe the unusual mechanism of injury of this case and its clinical features. The surgical indications for penetrating injuries of th e spinal cord are discussed. Summary of Background Data: Spinal stab wound injuries are rare, and the li terature on the subject is scant. There has been only one large clinical re view from South Africa, published in 1977. The clinical features and the in jury mechanism of a laterally directed stab wound to the cervical spine hav e not been previously described. Methods: An 18-year-old man was stabbed in the right side of the neck at C1 -C2. The blade penetrated the spine laterally and went through the ligament s without affecting the bony structures. On admission the patient had tetra plegia and was in respiratory failure. Radiologic investigation showed the retained blade passing through the cord but showed no bony or vascular inju ries. Results: Before extraction, the knife was followed to its tip with careful dissection. Because no cerebrospinal fluid leak was noted in the area, the dura was not exposed. After surgery, magnetic resonance images showed a com plete transection of the spinal cord at C1-C2. The patient was neurological ly unchanged in follow-up examinations. Conclusion: Laterally directed horizontal stab wounds of the spine are part icularly dangerous because the blade can pass between two vertebrae to tran sect the cord. The neurologic injury that results is irreversible. The more common stab wounds, inflicted from behind, usually produce incomplete cord damage.