*2.2.1. Radiography*

The possible neurological deficit ranges from asymptomatic dural tears through different nerve root injuries, ranging from neurapraxia to neurothemesis and ending in the worst cases

The most common incomplete NMPSCI reported was the Brown-Sequard syndrome [15, 16]. This syndrome was first described by Charles-Édouard Brown-Séquard, in farmers cutting sugarcanes in Mauritius and sustaining hemisection of their spinal cord by long knives (1852)

Neurological injury to the spine may occur in two different mechanisms: immediate, through direct damage to neurological tissue, and delayed, following vascular injury to one of the feeding vessels in which a vessel that supplies the cord, most commonly the aorta or the Adamkiewicz perforant, is injured. The first one will cause most frequently an incomplete SCI, most commonly Brown-Sequard syndrome, while the last one is more likely to cause a complete SCI. The second pattern is the delayed onset which is caused most commonly from CSF leaks, edema, granuloma, scar formation, and infection. The delayed pattern can appear anytime from 2 years after the injury and up to 36 years as was described in a rare case of

All NMPSCI patients should be treated like other trauma victims according to the ATLS (Advanced Trauma Life Support) principles [20]. When the retained weapon is clearly prominent from the patient's body, the attention of the treating personnel tends to focus on it and distract them from acting according to the ATLS protocol. These injuries are sometimes less visible than it might be seen at first and may harbor other damages such as large vessels, heart, tracheal, or lung injuries that can affect hemodynamics, airway, and breathing and may be fatal. This is why any suspected patient should obtain an appropriate initial assessment and resuscitation before taking the next step. The initial assessment should not delay instance

Extracting the penetrating object must not be done on site, not even at the emergency room, before obtaining proper imaging studies. These should include radiographs, sonography, and computerized tomography, according to the involved area. In case the patient is hemodynamically unstable and does not respond to initial resuscitation, an immediate transfer to the

NMPSCI always entails the risk of a retained foreign body material. It is well described in the literature [12, 21]. Patients presenting with delayed wound infections following stab wounds that were irrigated and primarily sutured without further evaluation were documented [22–24]. This is why many authors recommend routine imaging of any penetrating injury, even if only a

There are many imaging modalities that can be used to evaluate patients with NMPSCI. This includes plain radiographs, upper GI studies, ultrasound, computed tomography with or

with complete or incomplete spinal cord injury.

70 Essentials of Spinal Cord Injury Medicine

**2.1. Primary evaluation: emergency department**

evacuation with minimal movements to the nearest hospital.

operating room with no further delay must take place.

**2.2. Imaging**

skin or fascia discontinuity is observed, with no obvious damage.

[17]. The syndrome is still the most common incomplete SCI [18].

metal encrustation of a retained knife fragment in the spinal canal [19].

Enicker and his colleagues [12] published a large series of stab wounds that accounted for one-third of all SCI in their center. Forty-nine percent of these patients had retained foreign bodies where a knife blade was the most common object. Knife blades are easily identified by plain radiographs; however, the availability of CT scan in most ER in the developed world has shoved aside its role in cervical trauma. It still has a role in the evaluation of thoracic injury mainly for the evaluation of the associated lung injury and not for the demonstration of the foreign body.
