Today’s case this 25 year old male walked in the ER an obvious neck malformation. He has a knife sticking out his posterior neck and was expedited to a trauma bay. There was no history provided as to how this happened, but I’m pretty sure we can assume he didn’t trip and fall backwards onto the knife. Neurosurgery was immediately consulted and ordered a CTA of the head and neck, as well as, a barium swallow study. Other than limited range of motion in the neck due to the having a giant knife out of his neck, exam showed no neurological deficits (CN 2-12 intact, strength 5/5 in bilateral upper/lower extremities, sensation intact, and deep tendon reflexes 2+ bilaterally), no CSF leaks or meningeal signs, no trouble swallowing, and no vomiting/coughing up blood.
Neurosurg reviewed the imaging with the radiologist and did not see any vessel, organ, or cord abnormalities. This means the knife missed all major arteries (i.e. vertebral, carotids, and aorta), organs (ie. esophagus and trachea), and did not cause spinal cord compression (i.e. via edema, hematoma formation, or displaced vertebral fractures). Obviously, with any major vessel being punctured, we worry about the patient bleeding out. With something like a tracheal penetration, we worry about losing an airway or with an esophageal perforation, we worry about air getting into the mediastinum, causing mediastinitis, which is highly fatal. Lastly, cord compression can cause major issues to the peripheral nervous system. Most notably, if the nerves that innervate the diaphragm, you could lose the ability to voluntarily breath which is not compatible with life.
Neurosurg was able to widen the entry point and deftly pull the knife out of the patient’s neck. As seen on the scan/XR, the knife passes through two vertebrae; specifically the lamino-facet junction which appears to be C3/C4? A laminectomy was performed, which is a removal of part of the vertebra (not sure if there was a fusion or graft done). Post op, serial neuro checks and prophylactic antibiotics will be necessary. All in all, this dude came out extremely lucky that he wasn’t dead on the spot from this unfortunate stabbing!