Stab wounds of the spinal cord represent approximately 26% of all spinal cord injuries[6,10] and remains the most common cause of traumatic Brown-Séquard syndrome[3,7,9,11,12,13,15]. In this case, the patient had a picture of post traumatic Brown-Séquard syndrome like picture with complete recovery of the motor functions in a 3 month period with persistent sensory on the right side. Middleton et al describe in their study that approximately 42% of patients with traumatic SCI have complete dysfunction without any movement or sensation below the site of injury and this may not be applicable to penetrating trauma to spinal cord, nevertheless it gives us an account of the severity of the pathology and clinical implications . They have also eluded to the fact that only 14.3% of all SCIs are believed to be anatomically complete injuries, while the remainder of SCIs are considered as an incomplete functional deficiency with a few spared connections that could be established under proper interventions . In this case, the knife injury had resulted in a hemi section of the cord contributing to incomplete functional status. It is useful to note that the therapeutic options for traumatic SCI includes surgical decompression, anti-inflammatory drugs, hyperbaric oxygen therapy, and rehabilitation interventions. SCI is still associated with a high disability rate despite the intensive rehabilitation programs carried out in hospitals worldwide [1,14,16].
In the case described one may argue if microsurgical repair is superior to just removal of the knife without repair of the cord or instillation of fibrin glue to the severed margins. There is no evidence to prove the efficacy of a specific technique leading to good functional recovery. Administration of Dexamethasone in this case is following the observation of the severed cord and the rationale can be questioned. Dural reconstruction following cord repair is vital in preventing post-operative complications compromising recovery.
The clinical outcomes of SCI depend on the severity and location of the lesion and may include partial or complete loss of sensory and/or motor function below the level of injury. Literature describe that cervical level of the spinal cord (50%) with the single most common level affected being C5 and the thoracic level (35%) and lumbar region (11%) in case of Traumatic SCI [6,8]. In case of penetrating cord injury the etiology is varied and there is report of penetrating missile injury and management by Kumar et al  where the emphasis on conservative management to surgical removal of the foreign body to avoid iatrogenic deficits. There are reports of accidental penetrating injury to cord secondary to Nail gun injury and wooden fragment penetration causing cauda equina syndrome where role of surgery is described [18-20].
With recent advancements in medical procedures and patient care, SCI patients often survive these traumatic injuries and live for decades after the initial injury . Studies have shown that 40-year survival rate of these individuals was 47% and 62% for persons with tetraplegia and paraplegia, respectively [9,16].The life expectancy of SCI patients highly depends on the level of injury and preserved functions. Mary Joan Roach et al in their recent study have concluded that the patients with penetrating SCI showed more complete injuries and lower surgery rates with worse functional outcome at one year . In our case, these evidence gives us an understanding of long term implications in the management of SCI. Kevin Morrow et al have concluded in their analysis pertaining to penetrating SCI that younger patients are affected and they utilize more health care resources. Surgery is undertaken to limiting progression of neurological deficits, stabilization and to control infection .
In this case, the patient had signs and symptoms of Incomplete cord injury/ Brown-Sequard syndrome that was successfully managed with timely surgical intervention, intense post-operative care and physiotherapy. There is evidence to support that Neuroplasticity plays an important in SCI recovery and physiologically based approach for the rehabilitation of walking has developed, translating evidence for activity-dependent neuroplasticity and the neurobiological control of walking [4,5] . Neuroplasticity occurs at multiple levels following SCI: Cortical, subcortical, brainstem and spinal cord both short-term and long-term, supporting the need for long term rehabilitation in these cases .
There is a paucity of reports eluding to repair of the spinal cord secondary to stab injury and particularly to the thoracic spine. Spinal cord repair is technically feasible however several factors should be considered, particularly the nature of injury, type of the foreign body, age of patient, time to repair from trauma and neurological status of the patient along clear understanding of treatment options. This case demonstrates that with multidisciplinary input, a combination of prompt surgical intervention and rehabilitation has helped an adult patient with penetrating stab injury to the spinal cord.