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CHAPTER 14
muscles and the plantarflexors of the feet, while the extensors still remained paralysed.
Through increased spasticity in both lower limbs she developed very marked plantar-
flexion contractions on the left which necessitated a lengthening of the Achilles tendon
on 23 May 1966 after which her walking capabilities greatly improved and the spasticity
greatly decreased. She was discharged on 30 June 1966. On 27 September 1966 and 12
May 1967 check ups, bladder and bowel function were normal. Her gait was spastic but
individual muscles on the left were of full power and so were the proximal muscles of the
right leg, but the tibialis anterior and peronei were still paralysed. Sensation had also
improved but there were still patches of analgesia and hypoalgesia below Tio.
These cases show interesting symptoms of scattered injuries to the spinal cord
resulting in incomplete lesions of dissociated type.
In certain patients the impact of the weapon may produce a Centre Coup action on
the cord. Although the cord at the site of the impact may remain intact by the violence,
the spinal cord may be pushed against the wall of the spinal canal and the clinical symp
toms may be produced by the damage to the opposite side of the spinal cord.
In 4 per cent of Lipschitz's material, infection occurred either in the form of menin
gitis or abscess formation. Abscesses may be intra- or extradural and in some patients a
chronic granuloma developed, especially when the patient was treated with antibiotics.
Both abscesses and granulomas may increase in size and result in an increase of the
neurological deficit. In chronic granulomas it may take weeks or even months until
signs of compression become apparent.
TREATMENT OF STAB WOUNDS
The initial treatment consists of debridement of the wound and suture in combination
with antibiotic treatment. The management of the paraplegia is, of course, the same as
outlined in previous chapters. As the stability of the spine is, as a rule, not disturbed,
early mobilization of the patient should be instituted. The indications for operations are:
1
Removal of the retained foreign bodies, such as the broken off tip of the weapon,
after careful preparation of the patient.
2 Treatment of C.S.F. leakage which does not cease within 3 or 4 days. Lipschitz
excised the skin and damaged muscles of the wound which were then resutured. In
contrast to Rand & Patterson (1929) and St John & Rand (1953) wno carried out laminec-
tomy to reduce the compression, Lipschitz did not find this ever necessary in his own
cases and feels that surgical procedure, apart from the indications mentioned above, is as
unnecessary as it is hazardous.
3
If the knife, following damage to the spinal cord, has remained embedded in the
vertebral body, a Brodie abscess of the vertebra may develop as the result of the broken
off tip of the knife. The treatment of this abscess may take several months. The foreign
body must, of course, be removed.
4
If a granuloma or late abscess produce increasing neurological symptoms, laminec-
tomy is, of course, indicated.
