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

OBJECTIVE: 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.

METHOD: 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.

RESULTS: 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.

CONCLUSION: 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.