Lumbar Plexopathy Due to a Gunshot Wound without Direct Trauma

Abstract

Lumbar plexopathy resulting from gunshot wounds is rare and is typically associated with open or penetrating injuries. We report a case of lumbar plexopathy caused by a gunshot wound without direct trauma to the plexus. A 77-year-old woman visited the emergency room with a gunshot wound incurred accidentally by a hunter. The entry wound was located on the right lower back, with the exit wound on the left upper arm. The projectiles remained lodged in the paraspinal muscles and had not traversed the fractured vertebral body. Following an emergent left lower pulmonary lobectomy, the patient reported paresthesia and a tingling sensation on the lateral aspects of both thighs. Electrophysiological studies indicated bilateral upper lumbar plexopathy with direct injury to the paraspinal muscles. A low-velocity shotgun injury can transform into high-energy trauma due to the direct impacts of the projectiles, secondary shock waves, and cavitation effects. When neurologic symptoms manifest along a specific dermatome in the lower extremities after a gunshot wound to the lower back, clinicians should consider the possibility of plexopathy, even in the absence of direct trauma to the plexus.