Retained intraspinal bullet--an illustrative case report.

In a 35 year old male who had suffered a gunshot injury one bullet remained in the spine at level C 5. Clinically, a complete high tetraplegia was found. Already during the first months after trauma the patient complained of dysaesthesia and hyperaesthesia in the segments at, and above, the lesion. Five years later, when the authors saw the patient, he reported on an increase of intensity of this pain since some months. This gave occasion to radiological investigations to rule out morphological changes as the origin of the increase in pain. CT showed a compact bullet exactly intraspinal, with a syringiform cyst projecting into the myelon. Since former CT scans did not exist, an objective statement on progress could not be given. However, it is suspected that chronic inflammation caused by metal breakdown products of the bullet may have contributed to the increasing pain. It is pointed out that it is necessary to take account the kind of metal when deciding for or against the removal of a foreign body.