Gunshot Wound in Lumbar Spine with Intradural Location of a Bullet

Abstract

The presence of a migratory bullet in the spinal canal after a gunshot injury is a rare finding, specially without causing permanent neurologic damage. We present the case of a patient who suffered a gunshot wound with an entry point in the posterior arc of L2-L3 and a migratory bullet detected at the level of L5-S1 in the CT scan. The patient complained about intense headache, dizziness, and variable sensitive impairment in lower legs apparently depending on the patient's position in bed. We decided to remove the bullet in order to prevent the delayed neurological damage and lead toxicity. We discuss technical details of this surgery.

Epidemiologia do traumatismo raquimedular por projéteis de armas de fogo em um hospital de referência no estado do Pará

“…Existe consenso na literatura de que as lesões por FAF são de tratamento conservador em grande parte dos casos, seja porque as fraturas causadas são geralmente estáveis ou porque a descompressão medular nem sempre é indicada. 18,[34][35][36] Entre os pacientes tratados cirurgicamente, apenas um não apresentava o projétil com trajeto intracanal. Dados semelhantes foram encontrados por Benato et al, 33 que tratou cirurgicamente todos os projéteis que estavam dentro do canal medular.…”

Thoracic and lumbar fractures in adolescents. An eight-year study

“…When spinal fracture in adolescents is caused by a road accident, there is a high likelihood for abdomen and thorax-associated injuries to occur, whereas when fractures are caused by falls, there is a high likelihood for lower-limb-associated injuries to occur. Of note, 10 fractured vertebrae were found to be caused by FAP in seven adolescents of our series, which reflects the increased violence that is being experienced in large cities 5,6 .…”

“…It is caused by high-energy trauma, as in road accidents and falls, but when it occurs in small children, child abuse should be suspected 3,4 . Spinal injury caused by firearm projectile (FAP), which is often seen in military populations, is currently showing an increase in civilian population, owing to easy access to firearms acquisition in an unauthorized or illegal form 5,6 . Nearly 32% of patients with neurological lesions associated with spine fracture are not diagnosed at the moment of injury, especially patients who have decreased level of consciousness owing to head injury and patients with associated damage to the pelvis and limbs 7,8 .…”

Fracturas torácicas y lumbares en los adolescentes. Estudio de ocho años

“…Y cuando la fractura es causada por caí-das, existe una alta posibilidad de presentarse lesiones asociadas en las extremidades inferiores. Llama la atención las 10 vértebras fracturadas por PPAF en siete adolescentes de nuestra serie, debido al aumento de la violencia que se vive en las grandes ciudades 5,6 . El 13.5% de los pacientes del estudio que sufrieron daño neurológico inicial presentaron cambios significativos hacia la mejoría, a diferencia de lo que sucede en los pacientes adultos.…”

“…Es producido por traumatismos de alta energía, como sucede en los accidentes viales y en las caídas, pero cuando se presentan en niños pequeños se debe sospechar abuso infantil 3,4 . El daño a la columna por proyectil de arma de fuego (PPAF) suele verse en la población militar, presenta un incremento actual en la población civil, debido a la fácil disponibilidad para la obtención de armas de manera no autorizada o ilegal 5,6 . Cerca del 32% de los pacientes con lesiones neurológicas asociadas a la fractura de columna no son diagnosticados al momento del daño, principalmente en pacientes que presentan disminución del nivel de consciencia por traumatismo craneal y en pacientes con daños asociados en la pelvis y en las extremidades 7,8 .…”