Neurosurgical management of penetrating spinal injury

BACKGROUND: Penetrating spinal injuries are the third most common cause of spinal cord injury, exceeded only by motor vehicle accidents and falls. The spinal cord can vary from complete destruction to a normal appearing cord. There remains much controversy regarding the neurosurgical management of patients who sustain penetrating injuries of the spine. METHODS: Penetrating spinal injuries account for four to seven new cases of penetrating injury per million persons per annum. The initial management of penetrating spinal injury follows the principles of standard trauma care. Once the patient is hemodynamically stabilized and concomitant life- threatening injuries have been addressed, care can be directed toward the spinal injury. RESULTS: A meticulous neurological examination should be performed, including individual assessment of all muscle groups and sensory dermatomes. This examination becomes the baseline with which all subsequent examinations will be compared. The radiologic examination of the patient begins after all radiographs of higher priority have been obtained. CONCLUSIONS: Penetrating spinal cord injury is associated with significant morbidity. The optimal management for these patients has not been determined, however, spinal instability resulting from the initial missile injury is rare.