Thoracic Spinal Cord Stab Injury: A Case Report and Literature Review

Aurélien Ndoumbe^1*, Marc Leroy Guifo², Mathieu Motah³, Samuel Takongmo²

¹Faculty of Medicine & Pharmaceutical Sciences, University of Douala, Douala, Cameroon.
²Faculty of Medicine & Biomedical Sciences, University of Yaoundé I, CHU of Yaoundé, Yaoundé, Cameroon.
³Faculty of Medicine & Pharmaceutical Sciences, University of Douala, Douala General Hospital, Douala, Cameroon.

DOI: 10.4236/ojmn.2015.54019                

Abstract

Thoracic spinal cord stab injuries are rare lesions. A 17-year-old boy was stabbed on his back by his classmate when he bent forward to pick up his cloth from the ground. On admission, he presented with: complete paraplegia with muscle strength of zero on all muscle groups, complete anesthesia from dermatome 10 and below, acute urinary retention, and a four-centimeter wound on the thoracolumbar region from which cerebrospinal fluid mixed with blood was oozing out. A high-dose methylprednisolone protocol was started (30 mg/kg in one hour and then 5.4 mg/kg over 23 hours) an indwelling urinary catheter placed and sterile dressing of the wound done. Antibiotics and analgesics were also administered. The computed tomography scanning revealed a spinal cord transection at T10-T11 level with incarceration of the broken knife blade. An emergency thoracic laminectomy was performed. Removal of the broken knife blade revealed complete spinal cord transection with a compressive hematoma within the spinal cord which was removed by smooth suction. The spinal dura was sutured and the wound closed in many layers. On day 14 after surgery, sensitivity was recovered with 3 on 5 muscle strength in both lower limbs except for both feet where motor function remained null. Urinary retention and fecal incontinence persisted. The patient was discharged from our service for a rehabilitation center. At 32-month follow-up, neurological examination was unchanged although patient noticed a slight improvement of sphincter disturbances.

Keywords

Spinal Cord Injury, Thoracic Spine, Stab Wound, Knife, Seventeen-Year-Old Boy

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Waters, R.L., Sie, I., Adkins, R.H. and Yakura, J.S. (1995) Motor Recovery Following Spinal Cord Injury Caused by Stab Wounds: A Multicenter Study. Paraplegia, 33, 98-101. http://dx.doi.org/10.1038/sc.1995.23
[2]	Li, X., Curry, E.J., Blais, M., Ma, R. and Sungarian, A.S. (2012) Intraspinal Penetrating Stab Injury to the Middle Thoracic Spinal Cord with No Neurologic Deficit. Orthopedics, 35, 770-773. http://dx.doi.org/10.3928/01477447-20120426-40
[3]	Saeidiborojeni, H.M., Moradinazar, M., Saiediborojeni, S. and Ahmadi, A. (2013) A Survey on Spinal Cord Injuries Resulting from Stabbings; A Case Series Study of 12 Years’ Experience. Journal of Injury and Violence Research, 5, 70-74.
[4]	Elgamal, E.A. (2004) Complete Recovery of Severe Quadriparesis Caused by Stab Wound at the Craniocervical Junction. Neurosurgical Review, 28, 70-72. http://dx.doi.org/10.1007/s10143-004-0359-0
[5]	Yeung, J. and Karim, A. (2012) Complete Spinal Cord Transection from a Stab Wound with Surgical Precision. Journal of Emergencies, Trauma, and Shock, 5, 204. http://dx.doi.org/10.4103/0974-2700.96503
[6]	Wyndaele, M. and Wyndaele, J.J. (2006) Incidence, Prevalence and Epidemiology of Spinal Cord Injury: What Learns a Worldwide Literature Survey? Spinal Cord, 44, 523-528. http://dx.doi.org/10.1038/sj.sc.3101893
[7]	O’Neill, S., McKinstry, C.S. and Maguire, S.M. (2004) Unusual Stab Injury of the Spinal Cord. Spinal Cord, 42, 429-430. http://dx.doi.org/10.1038/sj.sc.3101602
[8]	Peacock, W.S., Shrosbee, R.B. and Key, A.D. (1977) Reviews of 450 Stab Wounds of the Spinal Cord. South African Medical Journal, 51, 961-964.
[9]	Lipschitz, R. (1976) Stab Wounds of the Spinal Cord. In: Vinjen, P.J. and Bruyn, G.W., Eds., Handbook of Clinical Neurology, North Holland Publishing, Amsterdam, 406-409.