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The role of tertiary neurosurgical intervention in non-missile penetrating injuries of the spine

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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.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Funding

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Authors and Affiliations

  1. Division of Neurosurgery, Stellenbosch University and Tygerberg Academic Hospital, Room 4024 Clinical Building, Parow, 7505, South Africa

    Paseka M. Seroto, Bradley M. Harrington & Adriaan J. Vlok

  2. Biostatistics Unit, Division of Epidemiology and Biostatistics, Department of Global Health, University of Stellenbosch, Stellenbosch, Western Cape, South Africa

    Carl Lombard

Authors
  1. Paseka M. Seroto
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  2. Bradley M. Harrington
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  3. Carl Lombard
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  4. Adriaan J. Vlok
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Corresponding author

Correspondence to Adriaan J. Vlok.

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The authors declare that they have no conflict of interest.

Ethical approval

Institutional and ethical approval was obtained under the Health Research Ethics Committee of the University of Stellenbosch Number N20/03/028.

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Seroto, P.M., Harrington, B.M., Lombard, C. et al. The role of tertiary neurosurgical intervention in non-missile penetrating injuries of the spine. Eur Spine J 30, 1397–1401 (2021). https://doi.org/10.1007/s00586-020-06665-4

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  • DOI: https://doi.org/10.1007/s00586-020-06665-4

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