Bullet retrieval from the cauda equina after penetrating spinal injury: A case report and review of the literature

Author:

Ojukwu Disep I.1,Beutler Timothy2,Goulart Carlos R.2,Galgano Michael2

Affiliation:

1. St. George’s University, School of Medicine, Great River, New York, United States,

2. Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, New York, United States.

Abstract

Background: When gunshot injuries occur to the spine, bullet fragments may be retained within the spinal canal. Indications for bullet removal include incomplete spinal cord injury, progressive loss of neurologic function including injury to the cauda equina, and dural leaks with impending risk of meningitis. Case Description: Here, we present a 34-year-old male with a missile penetrating spinal injury to the cauda equina. In addition to the computed tomography scan demonstrating retention of a bullet in the left L1/2 disc space, the scan suggested likely dural injury. The patient underwent a decompression/instrumented fusion with retrieval of the retained bullet fragment. A laminectomy was performed from T12 to L3, and at L1 and L2, a large traumatic durotomy was identified and repaired. The patient, unfortunately, continued to have bilateral lower extremity plegia with neurogenic bladder/bowel dysfunction at 1-year follow-up. Conclusion: We discuss the operative management and provide an intraoperative video showing the bullet extraction and dural closure.

Publisher

Scientific Scholar

Subject

Clinical Neurology,Surgery

Reference8 articles.

1. Missile injuries of the spine;Bhatoe;Neurol India,2003

2. Wandering intraspinal bullet;Gupta;Br J Neurosurg,1999

3. Bullet injury to the atlanto-axial region;Gupta;Neurol India,2006

4. Intradural migration of a bullet following spinal gunshot injury;Kafadar;Spinal Cord,2006

5. Penetrating spinal injuries and their management;Kumar;J Craniovertebr Junction Spine,2011

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