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 45-year-old male presented to the emergency department with alleged history of getting hit over the left side of neck by some air-borne object while standing on the roadside. This was followed up with severe, piercing pain in the neck region associated with bleeding from the wound site. He also gave history of transient loss of consciousness but had no neurological sequelae thereafter. There was no history of difficulty in breathing, change in voice, or swelling over the neck or face. On examination, his vitals were stable. There was no respiratory distress. There was a 2 cm × 1 cm linear lacerated wound on the left side of neck at the junction of upper 1/3rd and lower 2/3rd of the sternomastoid muscle on its anterior border. There was no active bleed or crepitus at the time of examination. No foreign body was visible or palpable in the neck. Indirect laryngoscopic examination was normal. An X-ray of the cervical region showed a radio-opaque foreign body in the left side of neck suggestive of a pellet (). A CT scan was ordered before taking up the patient for an exploration and removal of the foreign body. The scan confirmed the position of the pellet as being medial to the sternomastoid around the level of the glottis (Figures and ).\nThe neck was explored under general anaesthesia. On going medial to the sternomastoid, a thrill was palpable over the carotid sheath proximal to the foreign body. The pellet was identified within the carotid sheath partially piercing the internal jugular vein such that a part of it was outside the vessel and half of it was within the lumen. The pellet was carefully removed. The bleed was controlled with local pressure, and the vein was ligated and transfixed both proximal and distal to the site of injury.\nThe postoperative period was uneventful, and the patient is asymptomatic in his follow-up visits.