A Unique Case of an Arrow-Related Penetrating Spinal Cord Injury in Kenya and a Comprehensive Literature Review

TL;DR

This paper presents a rare case of an arrow-related spinal injury in Kenya and reviews the best treatment strategies for such injuries.

Contribution

The paper provides a unique case and literature review on managing arrow-induced spinal injuries, emphasizing challenges in resource-limited settings.

Findings

Maintaining elevated mean arterial pressure is not supported for penetrating spinal injuries.

Prophylactic antibiotics and early surgical intervention are effective in preventing infection.

Spinal decompression's benefits for penetrating injuries remain unclear due to limited evidence.

Abstract

Penetrating spinal cord injuries from arrows are rare. Arrowhead extraction can be challenging due to proximal critical neurovascular structures and tip variation. Our study highlights the most appropriate management plan based on our experience and current literature.

Literature search on PubMed and Google Scholar was performed. This review examines optimal surgical management strategies, mean arterial pressure (MAP) evaluation, antibiotic protocols, and recovery timelines. Additionally, we investigate spinal cord decompression, focusing on its potential to reduce edema and accelerate recovery. Our study includes one case of a 32-year-old cervical penetrating spine injury caused by an arrow.

Literature recommends maintaining an MAP of 85 to 90 mm Hg for 7 days following blunt spinal cord injury. Evidence for penetrating injuries is limited and suggests no improvement with MAP augmentation. Prophylactic broad-spectrum antibiotics, for 48 hours, appear effective in preventing infection and early surgical intervention. Our patient had an incomplete spinal cord injury with preserved motor function in the right (dominant) hand and decreased motor function (3/5) in the left C8–T1 level. Careful planning must consider the shape of the arrow and the anatomy. Removal of the arrow tip requires proximal control, with additional consideration for dural repair.

This case underscores the rarity and challenges of treating arrow-induced spinal cord injuries, particularly in resource-limited settings. Unlike blunt trauma, insufficient evidence supports elevated MAP or decompression for penetrating injuries. The primary management goal remains the safe, timely removal of the arrow and prophylactic antibiotics. Further research is needed to develop a standardized management protocol.

Figures