SA Orthopaedic Journal
On-line version ISSN 2309-8309
Print version ISSN 1681-150X
BACKGROUND: Anterior stab wounds to the spine are extremely rare. Depending on the weapon, trajectory and anatomical level, patients are likely to present with associated damage to large vessels, the lungs, heart, and the gastrointestinal, as well as genitourinary system. METHODS: In this case report, we describe the management of a 21-year-old male patient who presented with an injury to the cauda equina after an abdominal stab with a glass bottle. The patient escaped a thorough secondary survey and neurological examination due to massive intra-abdominal injuries, which required initial damage control surgery. Weak left-sided dorsiflexion of the ankle with paraesthesia in the left L4 and L5 nerve root distribution was initially overlooked. RESULTS: During a follow-up appointment, one month after discharge, chronic pain and cauda equina symptoms were noted. Further imaging revealed a large glass fragment, which had been driven, transabdominally, through the L4/L5 disc into the spinal canal. The fragment was removed through a posterior approach, which alleviated the chronic pain, although the neurological deficit remained unchanged. CONCLUSION: Neurological damage through anterior stab wounds to the spine has not yet been described. The best approach to these patients is a staged management initially directed at treating life-threatening injuries in the form of damage control surgery. Once stable, a thorough neurological reassessment must follow to rule out spinal cord injuries
Keywords : anterior stab to the spine; cauda equina injury; foreign body spine.