Migration of a bullet in the spinal canal.
ABSTRACT Migration of a bullet within the spinal canal after gunshot injury is rare. We report here the case of a penetrating gunshot injury of the lumbar spine at L3 with migration of the bullet within the spinal canal S2. The patient had marked paraparesis (proximal 1/5, distal 0/5 muscle strength) and anaesthesia at L3 and below, and had a hypocompliant, hyper-reflexive bladder with decreased capacity, and absent anal tonus. We removed osseous fragments in the canal with an L3 laminectomy and extracted the bullet by S2 laminectomy. After surgery, we observed an improvement in paraparesis, an increase in bladder capacity and urinary compliance, and improvement in anal tonus. The appropriate course of action in this type of injury remains unclear, because the number of cases described in the literature is not sufficient to provide a basis on which to make a definitive therapeutic decision. We herein review the literature describing cases in which a bullet in the spinal canal has migrated; we describe the treatment used and the outcomes in these cases.
Article: Gunshot injuries in the spine.[Show abstract] [Hide abstract]
ABSTRACT: Study design:Review article.Objectives:To review the literature regarding treatment approaches in cases of gunshot wounds (GSWs) affecting the spine.Setting:Brazil.Methods:Narrative review of medical literature.Results:GSWs are an increasing cause of morbidity and mortality. Most patients with spinal GSW have complete neurological deficit. The injury is more common in young men and is frequently immobilizing. The initial approach should follow advanced trauma life support, and broad-spectrum antibiotic therapy should be initiated immediately, especially in patients with perforation of the gastrointestinal tract. The indications for surgery in spinal GSW are deterioration of the neurologic condition in a patient with incomplete neurological deficit, the presence of liquor fistula, spinal instability, intoxication by the metal from the bullet or risk of bullet migration.Conclusion:Surgical treatment is associated with a higher complication rate than conservative treatment. Therefore, the surgeon must know the treatment limitations and recognize patients who would truly benefit from surgery.Spinal Cord advance online publication, 29 April 2014; doi:10.1038/sc.2014.56.Spinal Cord 04/2014; DOI:10.1038/sc.2014.56 · 1.70 Impact Factor
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ABSTRACT: We report the case of a 24 year old male who had a retained bullet within his thoracic spine from a gunshot wound resulting in paraplegia. After 7 months he began experiencing painful dysesthesias at his sensory level. Repeat imaging demonstrated migration of the bullet as well as the development of intramedullary dystrophic calcification associated with the bullet. This case demonstrates not only the ability for retained bullets to migrate within the spinal canal but also demonstrates they can lead to remote symptoms due to the development of dystrophic calcification.The Open Neuroimaging Journal 08/2012; 6:75-7. DOI:10.2174/1874440001206010075
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ABSTRACT: Long-term complications of retained war fragments in the body are not completely known. Also, bullet migration and slow resorption of metals and distortion in some imaging modalities are frequent and well recognized complications but, now we are concerned about neoplastic changes near the retained war fragments. We reviewed the literature on complication of retained war fragments and report our 2 cases of malignant changes around old retained war fragments in the limbs.