Radiation diagnosis of stab-and-cut wounds of the spinal cord. Application in forensic examination of living persons: a prospective study

INTRODUCTION : Stab wounds to the spinal cord are a rare but clinically significant problem. These injuries can lead to serious consequences. Modern methods of radiation diagnostics (CT and MRI) play a key role in their detection and differential diagnosis. The results are sent to forensic medical institutions for examination. The main task of a forensic medical expert in the examination of a living person is to establish the severity of harm to health. The medical criteria approved by the Decree of the Government of the Russian Federation No. 522 are the main document on which the expert relies. To qualify spinal cord injury as serious harm, it is necessary to prove a penetrating wound into the spinal canal on the basis of the paragraph «A wound penetrating into the spinal canal of the cervical, thoracic, lumbar or sacral spine, including without damage to the spinal cord and the «horse tail». Radiation diagnostic data are the main noninvasive methods capable of providing arguments for expert conclusions. OBJECTIVE : To evaluate the diagnostic capabilities of CT and MRI in spinal cord stab wounds based on the analysis of 9 clinical cases, as well as to determine the correlation between the lesion level, clinical picture and visual data. MATERIALS AND METHODS : The study included 9 patients (7 men, 2 women) with stab wounds to the spine and spinal cord aged from 23 to 49 years. All patients underwent CT and MRI at the place of hospitalization. To determine the severity of the injury, a forensic medical examination was conducted with the involvement of a radiologist. RESULTS : CT scans revealed damage to bone structures: 33.3% (fractures, subluxations). Traces of a piercing object: 66.7% (linear pressure channels). Pneumomyelia: 2 patients (violation of the tightness of the membranes of the spinal cord). According to the MRI data, a violation of the integrity of the dural sac was revealed: 100%. Myelopathy is 44.4% (hyperintensive signal, edema, hemorrhages). Hematomas: 33.3% (epidural and subdural). A correlation of clinical symptoms with the lesion level was noted. The cervical region has a pronounced neurological deficit (tetraparesis, hemiplegia). Thoracic region — bilateral sensorimotor deficit, pelvic organ dysfunction. Lumbar region — paresis of the feet, dysesthesia, without gross motor disorders. DISCUSSION : Stab wounds of the spinal cord (CRSM) represent a complex diagnostic problem that requires an integrated approach in judicial practice. Computed tomography (CT) effectively detects bone damage and analyzes the trajectory of a wounding object, while magnetic resonance imaging (MRI) detects damage to soft tissue structures. The results of the study show that CT is the most informative for bone injuries, while MRI is the most informative for assessing the condition of the spinal cord and soft tissue structures, including myelopathy and hematomas. Clinical data confirm that the severity of neurological deficits depends on the level of spinal cord injury, and the use of CT and MRI in forensic medical examination makes it possible to objectify the severity of injury and the mechanism of injury. CONCLUSION : The results obtained can be used to improve diagnostic algorithms and expert assessment of such injuries in forensic medical practice. In the future, it is necessary to expand the base of clinical observations and conduct comparative studies involving more patients in order to clarify diagnostic criteria and improve the accuracy of expert opinions.