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

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.