{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T01:05:46Z","timestamp":1771290346663,"version":"3.50.1"},"reference-count":20,"publisher":"Georg Thieme Verlag KG","issue":"01","license":[{"start":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T00:00:00Z","timestamp":1769731200000},"content-version":"vor","delay-in-days":29,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurol Surg Rep"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n                  <jats:p>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.<\/jats:p>\n                  <jats:p>Literature recommends maintaining an MAP of 85 to 90\u2009mm 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\u2009hours, 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\u2013T1 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.<\/jats:p>\n                  <jats:p>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.<\/jats:p>","DOI":"10.1055\/a-2798-9778","type":"journal-article","created":{"date-parts":[[2026,1,31]],"date-time":"2026-01-31T00:17:04Z","timestamp":1769818624000},"page":"e24-e29","source":"Crossref","is-referenced-by-count":0,"title":["A Unique Case of an Arrow-Related Penetrating Spinal Cord Injury in Kenya and a Comprehensive Literature Review"],"prefix":"10.1055","volume":"87","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9263-960X","authenticated-orcid":false,"given":"Filippos S.","family":"Chelmis","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Sofia University \u201cSt. Kliment Ohridski\u201d, Sofia, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fani C.","family":"Papacharalampous","sequence":"additional","affiliation":[{"name":"Medical University Sofia, Faculty of Medicine, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Iliana N.","family":"Sorotou","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Sofia University \u201cSt. Kliment Ohridski\u201d, Sofia, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paraskevas","family":"Pakataridis","sequence":"additional","affiliation":[{"name":"University Hospital \u201cLozenetz,\u201d Sofia University \u201cSt. Kliment Ohridski,\u201d Sofia, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hugh","family":"Williams","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tenwek Hospital, Tenwek, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Josephat","family":"Mburu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tenwek Hospital, Tenwek, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emmanuel","family":"Wekesa","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tenwek Hospital, Tenwek, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandru","family":"Budu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Queen Elizabeth Hospital, Birmingham, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2026,2,16]]},"reference":[{"issue":"04","key":"ref1","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1007\/s10143-018-01057-1","article-title":"Management of non-missile penetrating spinal injury","volume":"42","author":"D J Wallace","year":"2019","journal-title":"Neurosurg Rev"},{"issue":"10","key":"ref2","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1038\/s41393-022-00813-x","article-title":"Penetrating spinal cord injury: A systematic review and meta-analysis of clinical features and treatment outcomes","volume":"60","author":"O Bin-Alamer","year":"2022","journal-title":"Spinal Cord"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"107133","DOI":"10.1016\/j.ijscr.2022.107133","article-title":"Penetrating injury with an arrow impacted in the neck in rural Tanzania, a case report","volume":"94","author":"A Ismail","year":"2022","journal-title":"Int J Surg Case Rep"},{"issue":"05","key":"ref4","doi-asserted-by":"crossref","first-page":"1771","DOI":"10.1007\/s00381-020-04842-w","article-title":"An arrow that missed the mark: A pediatric case report of remarkable neurologic improvement following penetrating spinal cord injury","volume":"37","author":"L P Carlstrom","year":"2021","journal-title":"Childs Nerv Syst"},{"issue":"06","key":"ref5","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1016\/j.medin.2016.06.010","article-title":"Traumatismo cervical penetrante por flecha en intento autol\u00edtico. [In Spanish]","volume":"41","author":"V Mu\u00f1oz-Cruzado","year":"2017","journal-title":"Med Intensiva"},{"key":"ref6","first-page":"406","article-title":"Nonmissile penetrating spinal injuries: Mechanisms, expectations, and management","volume":"11","author":"B Fiani","year":"2020","journal-title":"Surg Neurol Int"},{"issue":"10","key":"ref7","doi-asserted-by":"crossref","first-page":"1933","DOI":"10.1007\/s00381-013-2095-7","article-title":"Pediatric arrowshot injury to cervical spinal cord-sagittal cord transection with no neurological deficit and good outcome: Case report and review of literature","volume":"29","author":"T Skadorwa","year":"2013","journal-title":"Childs Nerv Syst"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"105405","DOI":"10.1016\/j.clineuro.2019.105405","article-title":"Minimally invasive approach to non-missile penetrating spinal injury with resultant retained foreign body: A case report and review of the literature","volume":"184","author":"K Moldovan","year":"2019","journal-title":"Clin Neurol Neurosurg"},{"issue":"04","key":"ref9","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1016\/j.spinee.2003.07.007","article-title":"Pathophysiology and pharmacologic treatment of acute spinal cord injury","volume":"4","author":"B K Kwon","year":"2004","journal-title":"Spine J"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"17018","DOI":"10.1038\/nrdp.2017.18","article-title":"Traumatic spinal cord injury","volume":"3","author":"C S Ahuja","year":"2017","journal-title":"Nat Rev Dis Primers"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1016\/j.jocn.2019.06.018","article-title":"Non missile penetrating spinal injury","volume":"67","author":"J Yoon","year":"2019","journal-title":"J Clin Neurosci"},{"issue":"05","key":"ref12","doi-asserted-by":"crossref","first-page":"400","DOI":"10.3171\/spi.2006.4.5.400","article-title":"Nonmissile penetrating spinal injury. Case report and review of the literature","volume":"4","author":"K Shahlaie","year":"2006","journal-title":"J Neurosurg Spine"},{"issue":"12","key":"ref13","doi-asserted-by":"crossref","first-page":"1146","DOI":"10.1016\/j.crad.2009.06.004","article-title":"Imaging assessment of penetrating craniocerebral and spinal trauma","volume":"64","author":"C Offiah","year":"2009","journal-title":"Clin Radiol"},{"issue":"02","key":"ref14","doi-asserted-by":"crossref","first-page":"49","DOI":"10.4103\/joss.joss_1_22","article-title":"Non missile penetrating spinal cord injury: A case report and review of the literature","volume":"10","author":"B Diyora","year":"2023","journal-title":"J Spine Surg"},{"issue":"01","key":"ref15","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.anclin.2018.09.009","article-title":"Advanced Trauma Life Support\u00ae Update 2019: Management and applications for adults and special populations","volume":"37","author":"S M Galvagno Jr","year":"2019","journal-title":"Anesthesiol Clin"},{"issue":"05","key":"ref16","doi-asserted-by":"crossref","first-page":"2217","DOI":"10.4103\/0028-3886.359167","article-title":"Archer struck in neck","volume":"70","author":"D K Gupta","year":"2022","journal-title":"Neurology India"},{"issue":"S 01","key":"ref17","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1007\/s00586-016-4620-3","article-title":"Successfully treated transoral crossbow injury to the axial spine causing mild neurologic deficit: Case presentation","volume":"26","author":"V Z Kovari","year":"2017","journal-title":"Eur Spine J"},{"issue":"06","key":"ref18","doi-asserted-by":"crossref","first-page":"1397","DOI":"10.1007\/s00586-020-06665-4","article-title":"The role of tertiary neurosurgical intervention in non-missile penetrating injuries of the spine","volume":"30","author":"P M Seroto","year":"2021","journal-title":"Eur Spine J"},{"issue":"01","key":"ref19","first-page":"58","article-title":"Penetrating neck injury by an arrow: A paradigm of age old assault","volume":"12","author":"A Nepal","year":"2010","journal-title":"Nepal Med Coll J"},{"key":"ref20","first-page":"X241271809","article-title":"Arrowhead chronicles: A case series on arrow injuries in the head and neck region of Bhutanese archers","volume":"12","author":"S Jamtsho","year":"2024","journal-title":"SAGE Open Med Case Rep"}],"container-title":["Journal of Neurological Surgery Reports"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2798-9778.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T00:24:40Z","timestamp":1771287880000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2798-9778"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":20,"journal-issue":{"issue":"01","published-online":{"date-parts":[[2026,1,12]]},"published-print":{"date-parts":[[2026,1]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2798-9778","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["2193-6358","2193-6366"],"issn-type":[{"value":"2193-6358","type":"print"},{"value":"2193-6366","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,1,30]]},"published":{"date-parts":[[2026,1]]}}}