Study Design Case report and literature review.
To report the case of a patient who sustained a penetrating wound with a knife tip lodged in the craniovertebral spine and to review the literature.
Summary of Background Data
The incidence of vertebral artery injury (VAI) in penetrating neck trauma is around 7.4% for stab wounds. The surgical timing, approach and technique of foreign body removal are still controversial.
A 24-year-old male with a stab wound in the right occipital condyle presented with no neurologic deficits. Radiographs demonstrated a foreign body at the craniovertebral level. A CT angiogram was requested to rule out possible vertebral artery injury because of the level of injury. The knife tip was exposed using a posterior midline approach extended laterally to expose the occipital condyle, atlantal arch and vertebral artery. The knife was safely removed by being pulled along the axis of the knife trajectory.
The patient had no complications during and after the operation.
Cases of spinal cord injury or vertebral artery injury in which the foreign body is retained are uncommonly reported. Computed tomography (CT) angiography is strongly suggested for cervical penetrating wounds to rule out vertebral artery injury. Surgical approach should be individualized to prevent any further injury to the cord, nerve roots and vertebral artery.
Mamer S. Rosario, Mary Ruth A. Padua and Vernade May N. Santiago
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