Anouar Bourghli1, Safwat Abouhashem2, Rami Abo Wali2, Ibrahim Obeid3, Louis Boissiere3, Jean-Marc Vital3, Mohammed Al Sarawan2. 1. Orthopedic and Spinal Surgery Department, Kingdom Hospital, P. O. Box 84400, Riyadh, 11671, Saudi Arabia. anouar.bourghli@gmail.com. 2. Orthopedic and Spinal Surgery Department, Kingdom Hospital, P. O. Box 84400, Riyadh, 11671, Saudi Arabia. 3. Orthopedic Spinal Surgery Unit 1, Bordeaux Pellegrin Hospital, Bordeaux, France.
Abstract
PURPOSE: Gunshot injury to the spine can be devastating, and it has increased in the civilian population during the last decade. METHODS: We present the case of a 30-year-old male, who received a bullet in his back after exchange of fire with the police. Initial assessment revealed paraparesis with cerebrospinal fluid leak (CSF) from the bullet entry hole, CT scan showed metal debris with two bullet fragments in the L5/S1 right foramen and lateral recess, and another fragment in the central canal posteriorly, and also it revealed two fracture lines creating a right L5 "floating pedicle". RESULTS: The patient was taken to the operating room and underwent L5/S1 posterior approach with right L5 pedicle stabilization with a pedicle screw, removal of the bullet fragments, dural repair with a patch, L5/S1 posterolateral fusion, and insertion of a lumbar CSF drain. The patient could walk with a walking frame on day 7 with a satisfactory radiological result at 1 year but with a remaining partial motor deficit of both ankles, mainly on the right side. CONCLUSION: Literature contains a lot of controversies regarding the management of spinal gunshot injuries. The current case shows that early surgical management, when partial neurological deficit with a CSF leak is noted, could improve the clinical outcome and prevent related complications.
PURPOSE:Gunshot injury to the spine can be devastating, and it has increased in the civilian population during the last decade. METHODS: We present the case of a 30-year-old male, who received a bullet in his back after exchange of fire with the police. Initial assessment revealed paraparesis with cerebrospinal fluid leak (CSF) from the bullet entry hole, CT scan showed metal debris with two bullet fragments in the L5/S1 right foramen and lateral recess, and another fragment in the central canal posteriorly, and also it revealed two fracture lines creating a right L5 "floating pedicle". RESULTS: The patient was taken to the operating room and underwent L5/S1 posterior approach with right L5 pedicle stabilization with a pedicle screw, removal of the bullet fragments, dural repair with a patch, L5/S1 posterolateral fusion, and insertion of a lumbar CSF drain. The patient could walk with a walking frame on day 7 with a satisfactory radiological result at 1 year but with a remaining partial motor deficit of both ankles, mainly on the right side. CONCLUSION: Literature contains a lot of controversies regarding the management of spinal gunshot injuries. The current case shows that early surgical management, when partial neurological deficit with a CSF leak is noted, could improve the clinical outcome and prevent related complications.
Authors: Gursukhman S Sidhu; Arvindera Ghag; Vanessa Prokuski; Alexander R Vaccaro; Kristen E Radcliff Journal: Clin Orthop Relat Res Date: 2013-12 Impact factor: 4.176
Authors: Clifford L Crutcher; John M Wilson; Kevin D Morrow; Jessica A Shields; Lindsay M Lasseigne; Frank Culicchia; Gabriel Tender Journal: J Surg Case Rep Date: 2020-12-07