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Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2015; 34(03): 245-249
DOI: 10.1055/s-0035-1559889
Case Report | Relato de Caso
Thieme Publicações Ltda Rio de Janeiro, Brazil

Tratamento cirúrgico do traumatismo raquimedular por arma branca retida em coluna cervical: relato de caso

Surgical Treatment for Spinal Cord Injury Caused by Knife Held in Cervical Spine: Case Report
Bernardo Drummond Braga
1   Neurocirurgião do Hospital de Urgências de Goiânia (HUGO), Goiânia, GO, Brasil.
,
Thiago Dantas de Souza Azarias
2   Residente de Neurocirurgia do Hospital Geral de Goiânia (HGG), Goiânia, GO, Brasil.
,
Ariana Costa Cadurin
3   Acadêmico de Medicina da Pontifícia Universidade Católica de Goiás (PUC-GO), Goiânia, GO, Brasil.
,
Diego José Fernandes
3   Acadêmico de Medicina da Pontifícia Universidade Católica de Goiás (PUC-GO), Goiânia, GO, Brasil.
,
Oliver Vilela Gomes
3   Acadêmico de Medicina da Pontifícia Universidade Católica de Goiás (PUC-GO), Goiânia, GO, Brasil.
,
Carlos Roberto S.A. Drummond
4   Neurocirurgião do Serviço de Neurocirurgia e do Departamento de Cirurgia da Coluna Vertebral do HGG, Goiânia, GO, Brasil.
› Author Affiliations
Further Information

Publication History

06 June 2014

12 June 2015

Publication Date:
10 August 2015 (online)

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Resumo

As lesões traumáticas da medula espinhal provocadas por objetos perfurantes retidos são raras e configuram um desafio para o cirurgião da coluna vertebral. A cirurgia precoce pode minimizar o risco de sequela neurológica. Exames de diagnósticos por imagem são fundamentais para o planejamento e sucesso terapêutico, mas não devem retardar o tratamento cirúrgico. Os autores descrevem um caso de lesão medular por arma branca retida provocando a síndrome de Brown-Séquard e discutem a abordagem terapêutica. Os objetivos da cirurgia são a retirada do objeto retido, sem causar déficit motor ou sensitivo adicional, e a correção da lesão dural e de eventuais instabilidades da coluna.

Abstract

Traumatic spinal cord injuries caused by perforating retained objects are rare and challenging for spinal surgeons. Early surgery can minimize the risk of neurological sequelae. Diagnostic imaging exams are essential for planning and therapeutic success, but should not delay surgical treatment. The authors describe a case of spinal cord injury by stab retained causing Brown-Sequard syndrome and discuss the therapeutic approach. The goal of surgery is the removal of the object retained without causing additional motor or sensory deficit, fix the dural injury and possible spinal instabilities.

Palavras-Chave

traumatismos da medula espinhal - ferimentos perfurantes - síndrome de Brown-Séquard - coluna cervical - laminectomia - prognóstico

Keywords

spinal cord injuries - stab - Brown-Séquard syndrome - laminectomy - prognosis
 

  • Referências

  • 1 Del Bel EA, Silva CA, Mlasinic MO. Trauma raquimedular. Rev Coluna/Columna 2009; 8 (4) 441-449
    PubMedGoogle Scholar
  • 2 Brito LM, Chein MB, Marinho SC, Duarte TB. Epidemiological evaluation of victims of spinal cord injury. Rev Col Bras Cir 2011; 38 (5) 304-309
    CrossrefPubMedGoogle Scholar
  • 3 Velmahos GC, Degiannis E, Hart K, Souter I, Saadia R. Changing profiles in spinal cord injuries and risk factors influencing recovery after penetrating injuries. J Trauma 1995; 38 (3) 334-337
    CrossrefPubMedGoogle Scholar
  • 4 Waters RL, Sie I, Adkins RH, Yakura JS. Motor recovery following spinal cord injury caused by stab wounds: a multicenter study. Paraplegia 1995; 33 (2) 98-101
    CrossrefPubMedGoogle Scholar
  • 5 Rubin G, Tallman D, Sagan L, Melgar M. An unusual stab wound of the cervical spinal cord: a case report. Spine 2001; 26 (4) 444-447
    CrossrefPubMedGoogle Scholar
  • 6 Lopez AC. Tratado de Clínica Médica. Vol. II. 2ª ed. Roca; 2009
    Google Scholar
  • 7 Baghai P, Sheptak PE. Penetrating spinal injury by a glass fragment: case report and review. Neurosurgery 1982; 11 (3) 419-422
    CrossrefPubMedGoogle Scholar
  • 8 Thakur RC, Khosla VK, Kak VK. Non-missile penetrating injuries of the spine. Acta Neurochir (Wien) 1991; 113 (3-4) 144-148
    CrossrefPubMedGoogle Scholar
  • 9 Lipschitz R, Block J. Stab wounds of the spinal cord. Lancet 1962; 2 (7248) 169-172
    PubMedGoogle Scholar
  • 10 Peacock WJ, Shrosbree RD, Key AG. A review of 450 stabwounds of the spinal cord. S Afr Med J 1977; 51 (26) 961-964
    PubMedGoogle Scholar
  • 11 Lipschitz R. Stab wound of the spinal cord. Br J Med 1978; 1: 1093-1094
    CrossrefPubMedGoogle Scholar
  • 12 Cabezudo JM, Carrillo R, Areitio E, García de Sola R, Vaquero J. Accidental stab wound of the cervical spinal cord from in front. Acta Neurochir (Wien) 1980; 53 (3-4) 175-180
    CrossrefPubMedGoogle Scholar
  • 13 Defino HLA. Trauma raquimedular. Medicina Ribeirão Preto 1999; 32: 388-400
    PubMedGoogle Scholar
  • 14 Lee ST, Lui TN, Jeng CM. Spinal cord herniation after stabbing injury. Br J Neurosurg 1997; 11 (1) 84-86
    CrossrefPubMedGoogle Scholar
  • 15 Shahlaie K, Chang DJ, Anderson JT. Nonmissile penetrating spinal injury. Case report and review of the literature. J Neurosurg Spine 2006; 4 (5) 400-408
    CrossrefPubMedGoogle Scholar
  • 16 Jallo GI. Neurosurgical management of penetrating spinal injury. Surg Neurol 1997; 47 (4) 328-330
    CrossrefPubMedGoogle Scholar
  • 17 Ahn JY, Kim OJ, Song WS, Lee BH, Joo JY. Guglielmi detachable coils embolization of a penetrating vertebral artery injury: a case report. J Trauma 2003; 55 (6) 1171-1174
    CrossrefPubMedGoogle Scholar
  • 18 Mwipatayi BP, Jeffery P, Beningfield SJ, Motale P, Tunnicliffe J, Navsaria PH. Management of extra-cranial vertebral artery injuries. Eur J Vasc Endovasc Surg 2004; 27 (2) 157-162
    CrossrefPubMedGoogle Scholar
  • 19 Vinces FY, Newell MA, Cherry RA. Isolated contralateral vertebral artery injury in a stab wound to the neck. J Vasc Surg 2004; 39 (2) 462-464
    CrossrefPubMedGoogle Scholar
  • 20 Hindman BJ, Palecek JP, Posner KL , et al. Cervical spinal cord, root, and bony spine injuries: a closed claims analysis. Anesthesiology 2011; 114 (4) 782-795
    CrossrefPubMedGoogle Scholar
  • 21 Seo BR, Lee JK, Lee JH, Kim SH. An unusual stab wound causing a traumatic pseudomeningocele at the craniocervical junction. J Clin Neurosci 2009; 16 (10) 1365-1367
    CrossrefPubMedGoogle Scholar
  • 22 Williams DT, Chang DL, DeClerck MP. Penetrating spinal cord injuries with retained canal fragments. CJEM 2009; 11 (2) 172-173
    CrossrefPubMedGoogle Scholar
  • 23 Manzone P, Domenech V, Forlino D. Stab injury of the spinal cord surgically treated. J Spinal Disord 2001; 14 (3) 264-267
    CrossrefPubMedGoogle Scholar
  • 24 Lloyd RV, O'Flynn PE, Jones NS. Access to the traumatized vertebral artery: an unusual approach. J Laryngol Otol 1999; 113 (1) 76-78
    PubMedGoogle Scholar
  • 25 Koehler PJ, Endtz LJ. The Brown-Séquard syndrome. True or false?. Arch Neurol 1986; 43 (9) 921-924
    CrossrefPubMedGoogle Scholar
  • 26 Wolf SM. Delayed traumatic myelopathy following transfixion of the spinal cord by a knife blade. Case report. J Neurosurg 1973; 38 (2) 221-225
    CrossrefPubMedGoogle Scholar
  • 27 Rout D, Kak VK, Gulati DR. Stab injuries of the spinal cord. Neurol India 1978; 26 (4) 186-189
    PubMedGoogle Scholar
  • 28 Marshall LF, Knowlton S, Garfin SR , et al. Deterioration following spinal cord injury. A multicenter study. J Neurosurg 1987; 66 (3) 400-404
    CrossrefPubMedGoogle Scholar
  • 29 Berrington NR. Posttraumatic spinal cord tethering. Case report. J Neurosurg 1993; 78 (1) 120-121
    CrossrefPubMedGoogle Scholar
  • 30 Silberstein M, Hennessy O. Cystic cord lesions and neurological deterioration in spinal cord injury: operative considerations based on magnetic resonance imaging. Paraplegia 1992; 30 (9) 661-668
    CrossrefPubMedGoogle Scholar