• G Rubin, D Tallman, L Sagan, and M Melgar.
• Section of Neurosurgery, Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona 85724, USA. giorgiorubin@hotmail.com
• Spine. 2001 Feb 15;26(4):444-7.

Study DesignA rare case of a laterally directed stab wound injury of the cervical spinal cord is reported.ObjectiveTo 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.Summary Of Background DataSpinal 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.MethodsAn 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.ResultsBefore 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.ConclusionLaterally 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.

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