A 58-year-old male presented to the emergency department neurologically intact, but with a common kitchen knife penetrating the spinal cord at the T11 level. His only complaint was a patchy, vague, and subjective nondermatomal sensory loss in the lower extremities. A computed tomography (CT) image showed that the knife had pierced the right-sided interlaminar space at the T11-T12 level where it fully entered the spinal canal []. All plates were removed from an open Jackson table to allow the patient to be intubated in the supine position. After intubation, the patient was moved back to a stretcher in the lateral position, and a similar turn was utilized to re-position him in the prone position []. Baseline intraoperative neuromonitoring, including motor and somatosensory evoked potentials (MEPs and SSEPs, respectively), was utilized throughout positioning and surgery, and at no point were any significant intraoperative changes were observed.\nSubsequent to sterile preparation and draping of the patient, the skin was opened perpendicular to the axis of blade, with care being taken to avoid any undue manipulation. In addition, no electrocautery was utilized during dissection and removal of the knife to avoid potential damage to the spinal cord. The serrated knife was firmly embedded in the T11-T12 laminar bone. An ultrasonic bone cutter was used to create a bone island around the knife, allowing the knife and the surrounding T11-T12 laminae to be removed without traumatic rotational force to the spinal cord. Under microscope visualization, the dural laceration from the knife was extended in order to look for intradural compressive hematoma or vascular injury. Although neither was present, there was a clear laceration of the spinal cord itself. Following copious irrigation, watertight dural closure was performed using running 4-0 Nurolon sutures. In order to minimize infection risk given the foreign body penetration, no adjuvant sealant was used, especially because solid dural closure had been achieved. The patient was placed on antibiotics and received a tetanus shot. Postoperatively, the patient's motor status remained normal, whereas his mild diffuse sensory loss was unchanged. Three months later, the patient continued to have residual sensory deficit, but was fully ambulatory and returned to work.
A 58-year-old Iranian man presented to our emergency department after an air gun shot injury. On admission, a penetrating wound in the left lateral region of zone II of his neck was detected. His vital signs were normal. His only complaint was slight odynophagia. No bleeding, hematoma, dysphonia or subcutaneous emphysema was noticeable. On further investigation, anteroposterior and lateral X-rays showed a hyperdense pellet in the left latera region of his neck (Figure ). A computed tomography scan confirmed the presence of the pellet at the level of the thyroid cartilage (Figure ).\nOur patient underwent a neck exploration using a hockey stick incision. After the primary incision of the skin and platysma, the carotid sheath was explored with no findings of note. An intraoperative X-ray of his neck, using control needle markers, revealed a tiny orifice of about 1.5mm on the left superior part of the thyroid cartilage. Extending the orifice to 1.5cm showed a pellet between the cartilage and the lining mucosa (Figure ). The pellet was removed. After complete repair of the cartilage and placing a drain, the subcutaneous tissue and skin were repaired.\nOur patient was discharged after drain removal with good general health. On a two-year follow-up he did not report any problem or complication and his physical examination remained normal.