Imaging findings of penetrating spinal cord injuries secondary to stab wounds on magnetic resonance imaging in a tertiary trauma unit, South Africa

Abstract

Background: In South Africa, the leading cause of spinal cord injuries is motor vehicle accidents, followed by violence-related injuries, including gunshot injuries and stab wounds. Controversy regarding management persists. Magnetic resonance imaging (MRI) is the gold standard to rule out surgical causes of neurological deficit. Objectives: To determine the spectrum of imaging findings in penetrating spinal cord injuries, specifically related to stab wounds, in a Tertiary Academic Hospital in the Free State province and whether these imaging findings influenced immediate surgical decision-making and outcomes of patients. Method: Consecutive sampling was used to retrospectively select patients who presented with spinal penetrating injuries secondary to stab wounds during the period 01 August 2013–30 September 2016 and received MRI investigation. Fifty-six patients were included. Magnetic resonance imaging investigations were reviewed by the authors, with documentation of MRI findings, relevant patient demographics and clinical information into Excel spread sheets. Statistical analysis was performed by the Biostatistics Department of the University of the Free State. Results: The most common MRI finding was a high signal intensity wound tract (96.6%), followed by cord signal changes (91.1%) and cord oedema (82.1%). Thirty-nine extra-axial collections were diagnosed in 30 penetrating injuries, of which only one had spinal compressive effects. Four patients (7.1%) demonstrated pseudo-meningoceles. None of the included patients had an indication for emergency spinal surgery on review of imaging. Conclusion: Magnetic resonance imaging findings did not alter the surgical course of action in our study patients. Despite this, MRI is a valuable modality in evaluation of penetrating spinal cord injuries in the post-traumatic phase (24 h) for the presence of pseudo-meningoceles that pose an infection and delayed complication risk.

Keywords

• Spinal cord stab wounds
• MRI findings
• neurological performance
• trauma
• infection.