An unusual stab wound of the cervical spinal cord: a case report.
METHODS
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 the spinal cord are discussed.


BACKGROUND
Spinal stab wound injuries are rare, and the literature on the subject is scant. There has been only one large clinical review from South Africa, published in 1977. The clinical features and the injury mechanism of a laterally directed stab wound to the cervical spine have 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 ligaments without affecting the bony structures. On admission the patient had tetraplegia and was in respiratory failure. Radiologic investigation showed the retained blade passing through the cord but showed no bony or vascular injuries.


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 complete transection of the spinal cord at C1-C2. The patient was neurologically unchanged in follow-up examinations.


CONCLUSIONS
Laterally directed horizontal stab wounds of the spine are particularly dangerous because the blade can pass between two vertebrae to transect the cord. The neurologic injury that results is irreversible. The more common stab wounds, inflicted from behind, usually produce incomplete cord damage.
Section of Neurosurgery, Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona 85724, USA. giorgiorubin@hotmail.com
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Rubin
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Tallman
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Sagan
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Melgar
D000293:Adolescent; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D011782:Quadriplegia / Q000209:etiology / Q000473:pathology / Q000601:surgery; D013116:Spinal Cord / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D013119:Spinal Cord Injuries / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014951:Wounds, Stab / Q000150:complications* / Q000473:pathology / Q000601:surgery