The role of tertiary neurosurgical intervention in non-missile penetrating injuries of the spine
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ORIGINAL ARTICLE
The role of tertiary neurosurgical intervention in non‑missile penetrating injuries of the spine Paseka M. Seroto1 · Bradley M. Harrington1 · Carl Lombard2 · Adriaan J. Vlok1 Received: 15 September 2020 / Accepted: 10 November 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose The objective of the study was to determine whether all patients with spinal non-missile penetrating injuries (NMPIs) need to be managed at a tertiary neurosurgical centre. Methods A retrospective analysis of clinical, demographic, and imaging records was performed on all NMPI patients referred to the Department of Neurosurgery at Tygerberg Academic Hospital in Cape Town, South Africa, between 1 January 2016 and 31 December 2019. Results Ninety-six patients were identified (94 males and 2 females) with 35 cervical, 60 thoracic, and 1 lumbar spinal stab. Eighty-six had an incomplete spinal cord injury. Six patients presented with cerebrospinal fluid (CSF) leak, all of which resolved spontaneously. MRI was performed in nine patients. Six patients had retained blades, of which 5 were removed in the emergency room (ER). Surgery was performed in two patients (cervical intramedullary abscess and a retained blade). Two patients developed meningitis, and one an intramedullary abscess. Twenty-two patients had associated injuries (pneumothorax, bowel injury). The average length of stay was 17 days, with 81% being unchanged neurologically. The average time from discharge to leaving the hospital was 11 days. Conclusion Early management of NMPI should include prophylactic antibiotics and wound debridement and X-ray imaging to exclude retained blades. Bowel and lung injury must be managed accordingly. Tertiary neurosurgical referral is not routinely necessary and is only warranted for deteriorating neurology, retained blades not removable in the ER, and respiratory failure secondary to spinal cord injury. Complications include meningitis and persistent CSF leak, which should be referred timeously. Keywords Spinal cord injury · Stab spine · Non-missile penetrating injury · Retained blade · Tertiary-level intervention
Introduction Non-missile penetrating injury (NMPI) (stab) injuries of the spine are a rare type of injury in the developed world, with an incidence of 0.3% of all spinal cord injuries in the USA in 2013 [1]. The opposite is true in developing countries such as South Africa, with previously reported rates of 26% in 1977 and, more recently, 8.6% of admissions to an * Adriaan J. Vlok [email protected] 1
Division of Neurosurgery, Stellenbosch University and Tygerberg Academic Hospital, Room 4024 Clinical Building, Parow 7505, South Africa
Biostatistics Unit, Division of Epidemiology and Biostatistics, Department of Global Health, University of Stellenbosch, Stellenbosch, Western Cape, South Africa
2
acute spinal cord injury (ASCI) unit in Cape Town in 2015 [2, 3]. The outcome of this injury is variable and can be catastrophic due to neurological disability sustained from the primar
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