Abstract A 52-year-old female patient was admitted to the Emergency Department with an isolated thoracic spinal stabbing with a retained knife. She was haemodynamically stable a normal peripheral neurological examination. CT scan with 3D image reconstruction showed the blade had collided and lodged into the T11 vertebrae with the tip in close proximity but missing the spinal cord, aorta and inferior vena cava. A multidisciplinary team, including anaesthetists and vascular, neuro, and general surgeons, agreed upon the treatment strategy. The lodged knife was safely withdrawn in the operating theatre with the patient in prone position and under sedation and local anaesthesia. Following the procedure, neurological examination remained normal, and MRI scan revealed no spinal cord injuries. In this case report we discuss the initial approach to managing patients with a penetrating spinal injury. We elaborate on the role of pre-operative imaging using CT scan with 3D reconstruction, where possible, to assess the extent of injuries, as well as, the importance of timely input from multidisciplinary specialties based on the extent of the injuries. In case of a retained foreign body, we discuss how to extract it and importance of having contingency planning for any potential post withdrawal complications.