Surgical Treatment of Spinal Cord Trauma Caused by a Sharp Weapon Retained in the Thoracic Spine

Introduction: Traumatic brain injuries (TBI) caused by bladed weapons are more common in male patients between 16 and 30 years of age and can cause severe neurological sequelae. Objectives: To describe the case of a patient who was the victim of a stabbing attack, with thoracic SCI and hemopneumothorax, treated surgically. Methods: Medical records were analyzed and an integrative literature review was carried out. Case report: F.A.B., female, 46 years old, admitted to the Emergency Department with multiple stab wounds to the left posterior thoracic region. Computed tomography (CT) of the chest and thoracic spine revealed: moderate hemopneumothorax on the left and spinal cord transection by a metallic foreign body at the level of the T9 and T10 thoracic vertebrae. Neurological examination identified Brown-Sequard syndrome, with asymmetrical paresis and hypoalgesia on the less paretic side. On admission to hospital, thoracic drainage and right hemilaminectomy at T10 were performed to remove fragments of the bladed weapon from the thoracic spine, “local toilette” and correction of the cerebrospinal fluid fistula. On the seventh postoperative day, she presented with fever and chest pain, and a chest CT scan showed a retained hemothorax on the left. She underwent video-assisted pleuroscopy and drainage of around 1000 ml of pleural fluid, which was sent for culture, with no microbial growth. Empirical intravenous antibiotic therapy was also carried out to treat pleural empyema. The patient showed clinical improvement, lung re-expansion, was discharged from hospital and was referred for motor rehabilitation. Results: MTRs due to retained sharp objects are rare. Immediate neurological deficits occur due to direct injury by the foreign body, compression of a bone fragment in the spinal canal or ischemia secondary to vascular injury. Conclusion: Prompt medical attention with CT scans allows for the planning of early surgical procedures, which reduce potential sequelae and improve the neurological prognosis of victims of blunt force trauma.