Gunshot wound causing complete spinal cord injury without mechanical violation of spinal axis: Case report with review of literature

Abstract

Penetrating spine injury (PSI) forms the third most common cause of spine injury, only next to road traffic accidents and fall. Gunshot wound (GSW) forms the major bulk of PSI. Due to easy availability of firearms and antisocial behavior, GSW which were predominant in military population is now increasingly seen in civilized society. Here, we present a detail case review of unique case of civilian GSW indirectly causing complete spinal cord injury due to shock wave generated by the bullet, along with its systematic management.

Outcome and rational management of civilian gunshot injuries to the brain—retrospective analysis of patients treated at the Helsinki University Hospital from 2000 to 2012

“…In addition to our series, transventricular wound tract was associated with poor outcome in 14 of the prior studies identified in our literature search (Table 1 ), including the meta-analysis. The high energy of a bullet penetrating the tissues can produce a shockwave spreading in the tissues and causing neurological injury even when the actual wound tract is remote from the central nervous system [ 27 ]. Because the brain ventricles are filled with cerebrospinal fluid that surrounds all parts of the brain and is largely water which is an excellent conductor of shockwaves [ 30 ], the energy of a bullet passing through the ventricles might be transmitted more widespread in the brain tissue than the energy of a bullet passing only through brain tissue.…”

Intraspinal Bullet Migration: A Rare Case Report

“…This effect is higher in copper but less in lead. There is limited number of cases in the literature (1,3,6,7). Surgical removal of an intraspinal bullet may be further complicated by positional migration during operation.…”

“…(3,6). Most reported cases were caudal and cephalad migration has been reported only in 4 cases(7).Treatment is complex and still controversial. Some authorities advocate conservative treatment and others advocate surgery.…”

Delayed diagnosis of traumatic gunshot wound Brown-Sequard-plus syndrome due to associated brachial plexopathy

“…Some researchers describe concomitant injuries to the spinal cord and brachial plexus as very rare and others argue that this combination is under-reported although possible after high speed motor vehicle accidents [8,9,11,12]. In the civilian population GSW injuries usually present with vertebral fracture and direct involvement of the spinal cord [13]. However, penetrating bullets traveling at high speed create a shockwave that can cause cord contusion without directly passing through the spinal canal [13].…”

“…In the civilian population GSW injuries usually present with vertebral fracture and direct involvement of the spinal cord [13]. However, penetrating bullets traveling at high speed create a shockwave that can cause cord contusion without directly passing through the spinal canal [13]. In the absence of direct trauma to the spinal cord, several mechanical factors affect the severity of a GSW injury including the type of firearm weapon, path, speed, and size of the projectile, and distance between the firearm and the target [14].…”