A case report of firearm bullet settling into the thoracic spinal canal without causing neurological deficit or vertebral bone destruction

Minimally invasive retrieval of a bullet settling into the thoracic spinal canal in a pediatric patient: A case report

A 10-year-old boy presented to neurosurgery department after a gunshot wound to the upper thoracic spine. The bullet entered through the right deltoid muscle and lodged inside the spinal canal at T1 level. The patient arrived conscious and obeying commands; however, he experienced a loss of sensation below T3 level, loss of reflexes below the injured T1 level, loss of anal sphincter tone and paraplegia in the lower limbs (American Spinal Injury Association grade-A). Imaging studies revealed an intra-canalicular metallic bullet at the T1 level. The patient underwent urgent operation using a tubular retractor system and the microscope. Subsequently, the bullet was successfully retrieved. Postoperatively, the patient made a significant recovery and by the end of the 6th month, he was able to walk independently despite some gait instability. A minimally invasive approach for intra-canalicular bullet removal in the thoracic region is a safe and effective technique in pediatric patients.

Isolated L5 nerve root injury without osseous disruption in a case of gunshot injury to the paediatric spine—A case report

INTRODUCTION

There exists sparse literature on Gunshot injuries (GSI) to the pediatric spine, its natural course, management protocols and outcomes following surgical intervention. Here, we present a projectile injury to the paediatric lumbar spine without any osseous disruption in a 5-year-old child requiring surgical management.

CASE PRESENTATION

A 5-year-old child presented with a gunshot injury to the pediatric lumbar spine. On radiological imaging, there was no osseous disruption and an intraspinal canal projectile was embedded in an organised infected complex, compressing onto the left-sided L5 traversing nerve root with resultant grade 4 motor power of the left Extensor Hallucis Longus (EHL). Under fluoroscopic guidance using two separate mini-open incisions, the pellets were extracted. One from the spinal canal through left-sided L4 laminotomy and the other from the right paraspinal region. Post-surgical decompression and pellet retrieval there was gradual recovery to grade 5 motor power of Left EHL and improvement in the general condition of the child.

CONCLUSION

The absence of osseous disruption can be attributed to the size of the projectile, widely spaced interlaminar spaces in the lumbar spine due to the absence of lumbar lordosis in the pediatric group and flexibility of the pediatric spine owing to its ligamentous laxity.

A migrated knitting needle in a paediatric spine: case report

PURPOSE

The aims of this study were to present migration of a sharp metal material into the spinal canal in a paediatric patient and to discuss the management of metallic foreign bodies in the spinal canal.

METHODS

Patient's medical reports, radiological tests, review of intraoperative findings, and literature search were examined.

RESULTS

The migration and penetration of a knitting needle in a 7-year-old-boy are presented.

CONCLUSIONS

There is a significant risk of migration of penetrating foreign materials into the spinal canal. Early identification and removal of these foreign bodies retained in the spinal canal may be important even when the patient is asymptomatic.

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

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.

Upper cervical spinal cord gunshot injury without bone destruction

INTRODUCTION

This report describes a rare case of the gunshot injury of the spine and spinal cord.

PRESENTATION OF CASE

A rare case of the bullet lodged intra-durally in the upper cervical region without damaging the vertebrae or the spinal cord. The bullet was removed as microneurosurgical and duraplasty was performed.

DISCUSSION

Surgical management of the gunshot wounds of the spine and spinal cord is not widely advocated and controversial.

CONCLUSION

Advances in microneurosurgical instrumentation and microscopic techniques may open up a new era of surgical treatment of spinal cord gunshot wounds.

Prevalencia y evolución clínica de pacientes con heridas por arma de fuego en la columna vertebral

INTRODUCCIÓN: Objetivos: Determinar la prevalencia, mortalidad y evolución clínica de los pacientes con heridas por arma de fuego en columna vertebral y determinar si la extracción del proyectil mejora el estado neurológico de los pacientes. MÉTODO: Se realizó un estudio de serie de casos, donde se analizaron los registros de todos los pacientes con heridas por arma de fuego en la columna vertebral ingresados en la UMAE, Hospital de Especialidades del CMNO del IMSS, de septiembre del 2010 a septiembre del 2011, que eran compatibles con los criterios de inclusión, exclusión y de no inclusión. Se midió el grado de discapacidad de los pacientes mediante la escala de Oswestry. RESULTADOS: El grupo se formo por 13 (86,7%), pacientes del sexo masculino y 2 (13,3%) del sexo femenino, con edad media de 42 años y desviación estándar de 14 años. Las regiones más afectadas fueron torácica 7 (46,7%), cervical 5 (33,3%) y por último, lumbar con 3 (20%) pacientes; la estancia intrahospitalaria observada con mayor frecuencia fue 7 (13,3%) y 10 (13.3%) días, con 2 casos cada una; la estancia hospitalaria mínima fue de 3 días, con tan solo un (6,7%) caso y la mayor fue de 94 días, en 1 (6,7%) paciente. La estancia superior a 10 días ocurrió en 11 (73,3%) pacientes y la inferior a 10 días, en 4 (26,7%) pacientes. El tratamiento quirúrgico se realizó en 4 (26,7%) pacientes y 11 (73,3%) pacientes solo recibieron tratamiento clínico; la extracción del proyectil se efectúo en 3 (20%) pacientes, de los cuales 2 tuvieron infección. Se observaron complicaciones en 14 (93,3%) pacientes y tan solo en 1 (6,7%) no hubo complicaciones. En 6 (40%) pacientes ocurrió infección en comparación con 9 (60%) en quienes no la presentaron. El estatus neurológico mediante la escala de ASIA inicial predominante fue "A" en 7 (46,7%) y el ASIA final predominante fue "B" en 6 (40%) casos. Fallecieron 3 (20%) pacientes y 12 (80%) pacientes sobrevivían durante el periodo del estudio. El grado de discapacidad medido mediante la escala de Oswestry inicial mínimo fue de 18 puntos, el máximo de 94, con media de 62 y desviación estándar de 22.2. El Oswestry final tuvo una media de 58 puntos con desviación estándar de 23.5. CONCLUSIONES: En nuestro estudio podemos concluir que las heridas por arma de fuego en la columna, ocasionan un alto grado de discapacidad y evolucionan con alta morbilidad. A esto hay que añadir que tanto el tratamiento clínico cuanto el quirúrgico, no proporcionan mejoría sustancial en el estado neurológico y funcional del paciente. Tan solo se limitan a medidas de soporte para disminuir en lo posible las complicaciones, que a final de cuenta, son las que influenciarán en la calidad y sobrevida de los afectados. La extracción del proyectil y el tiempo transcurrido desde la cirugía no alteran el estado funcional final del paciente.

A firearm bullet lodged into the thoracic spinal canal without vertebral bone destruction: a case report

Introduction

Firearm injuries account for 13% to 17% of all spinal cord injuries, and are generally caused during warfare or assault with intent to kill. Spinal cord injuries caused by firearms are usually observed in patients aged 15 to 34 years old, and are especially common among men.

Case presentation

We report the case of a 28-year-old Iraqi man who was referred to our radiology department with lower limb paraplegia secondary to a gunshot wound. We performed 64-slice computerized tomography with two-dimensional and three-dimensional reconstruction of the thoracolumbar spine. On the two-dimensional and three-dimensional reconstructed axial images of the thoracolumbar spine, an intra-canalicular bullet nucleus was found at the mid-spinal cord at the T8 level, with no evidence of vertebral bone destruction.

Conclusions

To the best of our knowledge, there is only one previous report in the literature describing a case of a bullet nucleus lodged into the inferior epidural spinal canal without destruction of the vertebral bone. With the rise of violence worldwide the incidence of gunshot injuries continues to increase, and, thus, it is essential for radiologists to have a clear understanding of gunshot injuries and the findings on radiographic images.