Acute Spinal Cord Compression after Surgical Management for Stab Wound Injury to the Vertebral Artery

Abstract

Stab wounds associated with spinal cord and vertebral artery injury (VAI) are not common. There is no established surgical approach and management. A case of spinal cord compression due to tamponade for hemostasis of VAI is reported in this article. An 18-year-old boy with a stab wound to the neck was provisionally treated at a provincial hospital. After the initial surgery, he had no neurological deficit. A second operation was done for hemostasis of VAI by muscle tamponade. After the second operation, there was sudden diminished sensation and dysfunction of the left leg and arm. Magnetic resonance imaging showed spinal cord edema from the occiput to C2, and spinal cord compression at C1-2 by a large epidural hematoma. C2 laminectomy for decompression was done in a third operation. We removed a lot ofuscle from the spinal cord and at the C1-2 left foramen. Sudden massive arterial bleeding was encountered from the left VA. Hemorrhage was successfully controlled by compressive packing with muscle. The clinical signs and symptoms of the patient were clearly improved post-decompression. While bleeding caused by VAI can be controlled by hemostatic packing, there remains a risk of delayed hemorrhage from pseudoaneurysm formation.