Stab injuries to the spinal cord: a retrospective study on clinical findings and magnetic resonance imaging changes

This study was undertaken to document changes on magnetic resonance imaging (MRI) scans after a stab to the spinal cord. The aim of the study was to determine if routine MRI scans for this type of injury would lead to a change in management.

All patients with a stab wound to the spinal cord sustained between November 2004 and July 2005 were retrospectively enrolled. All of the patients were examined, a data form was completed, and MRI was performed within 72 hours on arrival at Groote Schuur Hospital.

Twenty-two patients were imaged during the study period. MRI results were reported by a neuroradiologist. The most common change seen on MRI scans was a spinal cord tract and cord signal change. Other imaging findings that were documented included cord swelling and extra-axial collections. Progressive neurological deficits developed in two patients, both as a result of sepsis. An intramedullary abscess was found on contrast follow-up imaging in only one of the two patients, and this was surgically drained. Five patients had extradural collections visible on MRI scans; however, all of these patients either had complete cord transection on MRI scans at the time of injury or in cases of incomplete injury (Brown Sequard syndrome), a tract was visibly affecting the hemicord that explained the injury and there was no mass effect from the extradural collection.

Routine MRI scans performed on admission of patients with stab injuries to the spinal cord did not lead to surgical intervention unless there was progressive neurological deficit. In such cases, a contrast MRI scan should be performed to rule out sepsis as the most likely cause of deterioration.