Bilateral Brown-Sequard syndrome regressing to anterior cord syndrome in spinal impalement: 2 unique cases with management pearls

Background Non-missile impalement spine injuries are quite uncommon. Most of these patients either present with impaling agent in situ or with a part of retained offending agent. Both the scenarios present unique management challenges especially if patients are clinically stable. The injury becomes more complex if multiple compartments like lung and abdomen also get involved. Non-missile penetrating spinal injury is rarely seen in the Indian settings. The world over it approximately accounts for 0.3-2.1% of spinal injuries. In view such meagre occurrence management decisions are usually driven based on surgeons' experience and patient's condition. Although conservative approaches for retained products have less complications as compared to surgery, long-term outcomes are not available for comparison. Unique management challenges are noted and described. Physical doctrines for management principles of such injuries are also attempted. Noteworthy is that their regression from complete cord syndrome to anterior cord syndrome is extremely short period. Case presentation We present 2 unique cases presenting as complete cord transection regressing from bilateral brown Sequard syndrome to anterior cord syndrome following decompression. Conclusion Spinal impalements are very rare especially now with strict societal regulations and criminal justice in place. Still now and then we do come across some staggering cases as described above. To establish a treatment protocol and management guidelines in such scarce scenarios is difficult. We attempt to underlie few basic doctrines in this regard with our experience in a tertiary centre.