Article

Migration of a bullet in the spinal canal

Department of Neurosurgery, Zonguldak Karaelmas University, TiP Fakültes, Hastanesi Nöroşirurji AD, Zonguldak 67600, Turkey.
Journal of Clinical Neuroscience (Impact Factor: 1.32). 02/2007; 14(1):74-6. DOI: 10.1016/j.jocn.2005.12.042
Source: PubMed

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.

0 Followers
 · 
104 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Craniocerebral and spinal penetrating trauma, which may be either missile (most typically gun-related) or non-missile (most typically knife-related), is becoming an increasingly common presentation to the urban general and specialized radiology service in the UK. These injuries carry significant morbidity and mortality with a number of criteria for prognosis identifiable on cross-sectional imaging. Potential complications can also be pre-empted by awareness of certain neuroradiological features. Not all of these injuries are criminal in origin, however, a significant proportion will be, requiring, on occasion, provision of both ante-mortem and post-mortem radiological opinion to the criminal investigative procedure. This review aims to highlight certain imaging features of penetrating craniocerebral and spinal trauma including important prognostic, therapeutic, and forensic considerations.
    Clinical Radiology 12/2009; 64(12):1146-57. DOI:10.1016/j.crad.2009.06.004 · 1.66 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The report of a rare case of lead poisoning by an intradiscal firearm bullet is presented. To describe and discuss the clinical and radiologic features (by computed tomography and magnetic resonance imaging) of a gunshot wound in the L2-L3 space which caused lead poisoning 5 years afterwards. Lead poisoning from firearm bullets is rare, but the possibility should be investigated in the case of bullets lodged in the joints. A 30-year-old man presented to the emergency room with an intense lumbar pain complaint, colic, intestinal constipation, insomnia, and progressive headache for 20 days. He had a history of a gunshot wound 5 years previously, and the bullet was left in situ, in the intravertebral disc between L2 and L3, as confirmed by radiographs, computed tomography, and magnetic resonance imaging. The hypothesis of lead poisoning was confirmed by the laboratory results. Chelation treatment with calcium versenate (disodium ethylenediaminetetraacetate, or CaNa (2) EDTA) was indicated. The patient was admitted and treated once again, before surgical removal of the bullet. After removal of the bullet, the patient had an episode of recurrence, and a new chelation cycle was performed, with complete resolution. Lead poisoning can result in severe clinical disorders that require rapid treatment. In this case, both clinical and surgical treatments led to complete resolution of the symptoms.
    Spine 02/2010; 35(4):E140-3. DOI:10.1097/BRS.0b013e3181ba023e · 2.45 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Ricochet of a bullet in the spinal canal is well known by neurosurgeons but relatively not a common event in usual medico-legal autopsy practice. This article presents a homicide case of a penetrating gunshot injury of the lumbar spine through the T12-L1 intervertebral foramen with active movement of the projectile within the spinal canal to the L5-S1 level. This case illustrates a bullet intradural and intramedullary active movement because of a ricochet of the body of T12 with active redirection of the path. In the current literature, different types of migration in caudal or cranial direction, intradural, or intramedullary are reported. If spontaneous migration of T10 to S1 seems to be more frequent, some authors reported a C1 to S2 migration. Such migration could be asymptomatic or induce neurological impairment. The medico-legal consequences of these migrations within the spinal canal are described.
    Journal of Forensic Sciences 04/2010; 55(5):1371-4. DOI:10.1111/j.1556-4029.2010.01439.x · 1.31 Impact Factor
Show more