Complete spinal cord transection from a stab wound with surgical precision.

Sir,

Stab wounds of the spinal cord are rare occurrences. Overall, the cause of spinal cord injury has been reported to be motor vehicle injury in 30%, gunshot wound in 35%, stab wounds in 26%, and miscellaneous causes in 9%.[1] When magnetic resonance imaging (MRI) is used to evaluate the extent of penetrating cord injury, the cord may appear as normal, partially transected, or completely transected.[2] We present a rare case of complete spinal cord transection demonstrated by MRI from a stab wound that displays an exceptionally precise cut through the overlying tissue, C7 spinous process, and the spinal cord.

A 53-year-old man presented to the emergency department with a glasgow coma scale score of 15 after sustaining a stab wound to the posterior neck. At presentation, he was unable to move his legs and he was unable to feel from the chest downward. On physical examination, sensorial examination showed anesthesia under the T2 dermatome. Motor strength of both his upper extremities was 4 of 5, but there was no motor strength detected in the lower extremities. There was decreased rectal tone. Emergent computed tomography without contrast of his cervical spine demonstrated a fracture of the C7 spinous process. T2-weighted MRI of the cervical spine demonstrated a complete T1 spinal cord transection and overlying knife track through the overlying skin and soft tissue [Figure 1]. The patient later developed spinal shock requiring volume resuscitation. During the hospital course, the patient developed ileus and subsequently developed respiratory failure. The patient died on day 7 of his hospital stay from acute respiratory distress syndrome.

Figure 1

MRI was performed on the day of trauma. T2-weighted sagittal MRI (echo time 117 ms; recovery time 3769 ms) of the cervical spine demonstrates a complete T1 transection of the spinal cord at the C7-T1 spinal level. A knife track through the overlying skin and soft tissue is noted

Stab wounds to the spinal cord are rare. A large study in South Africa in 1977 estimated that stab wounds may represent approximately 25% of all spinal cord injuries.[3] It was reported that 63% of the wounds were in the thoracic region, 30% in the cervical region, and 7% in the lumbar region.[3] However, in the United States, spinal cord injury comprises 2.6% of all trauma cases, with approximately 1% of those attributed to stab wounds.[4] Stab wounds causing spinal cord transection from the posterior aspect are uncommon due to protection by the spinous processes. The spinous process and transverse process would prevent a knife blade from crossing the midline before entering the ligamentum flavum. This case presents a unique scenario in which the knife stab was forceful enough to cause a clean cut through the C7 spinous process. MRI is useful in assessing the extent of spinal cord damage, as there is close correlation between location of the insult in the spinal cord detected by MRI and neurological findings.[5] Ventilatory support should be implemented on a case-by-case basis to prevent respiratory failure.