3 Nights: 3 Knives to the spinal column

It seems we were running a special on knives in the spinal column a few weeks ago.  First, we had a guy that had a knife directly into his spinal cord at T3.  INTO HIS SPINAL CORD (that deserves repeating by the way).  The amazing thing about this guy was that he only had a small sensory deficit in his right leg.  Otherwise he was completely fine.  Still walking.

The next night, we had this guy come in (yes, different patient, different knife):

It's interesting that the first two knives didn’t have their handles on them anymore.  I guess they just don’t make ‘em like they used to.  Apparently, wedging knives into the spine produces enough force to break off the handles of these second rate knives.  They’re definitely not Cutco quality.  Check out the x-ray and 3D recon images:

I feel like I’ve come full circle, because a patient with a knife in his back 7 years ago in the Bronx is what lit my fire for trauma surgery in the first place (I’ll tell you that story in person if you haven’t heard it yet, it’s a good one).  If it wasn’t for knives in peoples’ backs, I woulnd’t be here right now!

The second guy got incredibly lucky as well.  As you can see from the CT scan, the tip of the knife was just lateral to his spinal cord, wedged in between the facets of C5/C6.  The blade was tickling his right vertebral artery but didn’t do any damage to it!  

We were able to pull this knife out under local anesthesia in the Emergency Department.  He didn’t even have to go to the OR!  We observed him overnight and he walked out of the hospital the next morning.  He has no idea just how lucky he was...

I always try to save the best for last.  This final guy’s knife still had the handle on it (obviously a better quality) and it was stuck into the side of his Left chest.  He came in walking and talking, and initially we had NO IDEA how deep this knife went in.  When we got the x-ray, we were all blown away:

I’ve never seen anything like this.  The guy was completely stable, but he won himself a left sided thoracotomy so that we could be prepared for the worst when we pulled it out.  Miraculously, it came right out without any problems.  He walked out of the hospital 2 days later!  The blade went right behind his aorta and stopped when it hit his spinal column.  A centimeter difference and he would have been dead.  Another lucky dude who probably has no idea how lucky he really is.  I'm learning that luck is a relative term here in Africa.