Management of non-missile penetrating spinal injury

  • David J. WallaceEmail author
  • Christopher Sy
  • Geoffrey Peitz
  • Ramesh Grandhi


Review of the literature with case illustration. Non-missile penetrating spinal injury (NPSI) represents a small subset of spinal cord injuries at tertiary trauma centers and is comprised mostly of knife violence. Strict guidelines for the management of penetrating spinal cord injury remain elusive given the variability of mechanisms, rarity of clinical experience, and paucity of prospective studies. A review of the literature was conducted by search of the National Library of Medicine (PubMed) in the English language through June of 2018. Additional articles were culled from the reference lists of the included series. Eleven case series totaling 1007 patients, along with 21 case reports, were identified. In summary, magnetic resonance imaging (MRI) may be beneficial in assessing incomplete or progressive spinal injuries and can be considered with retained foreign bodies in select cases. Forty-eight hours of antibiotic prophylaxis is likely sufficient to prevent infection. Puncture wounds should be debrided, washed, and closed. Retained foreign bodies should be removed in the operating room and often require laminectomy. Early intervention is preferred. Non-missile penetrating spinal injury has a higher likelihood of neurologic recovery as compared to other traumatic spinal injuries.


Non-missile penetrating spinal injury Incomplete spinal cord injury Nail gun injuries Brown-Séquard syndrome 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest to report.

Statement of human rights

Informed consent was obtained from all individual participants and/or surrogates included in this manuscript. Additional informed consent was obtained from the patient whose de-identified intra-operative photographs are used in the figures.

Statement on the welfare of animals

This article does not contain any studies with animals performed by any of the authors.


Informed consent was obtained from the patient for the reporting of this case as well as use of photographs and images.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of NeurosurgeryUniversity of Texas Health Sciences Center - San AntonioSan AntonioUSA
  2. 2.Department of NeurosurgeryUniversity of Utah School of MedicineSalt Lake CityUSA

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