Introduction: Neurosurgeons are well aware of the devastating injuries which can be caused by gun shot wounds to the spine. The literature however remains unclear on the best management approaches of GSWs to the spine with retained fragments. To date there are very few reports in the literature describing intradural migration of bullets. There are no reports in the literature describing bullet entry into the thoracic spine with dural penetration cephalad migration into the cervical spine. All previous reports within the literature describe a caudal migration usually settling in the lumbar cistern. Most agree that surgery should be reserved for patients with progressive neurological deficits. In this case report we describe the management of our patient and a review of the literature on intradural migration.
Methods: In this case a 31yr m presented to the trauma service after a gsw to his left shoulder. The bullet passed through the left scapula where it caused a T2 lamina fracture, penetrated the dura causing a complete spinal cord injury at the T2 level, then lost its kinetic energy and migrated up to the C6 spinal level, resting within the spinal canal and compressing the spinal cord. In this case report we describe our justification for laminectomy and removal of the bullet fragment. We also discuss the clinical outcome after removal of the fragment and review the literature related to intradural migration of bullets.
Results: A C6 laminectomy was performed, the dura was opened and the bullet successfully removed. The patient made a significant clinical improvement immediately after the procedure with improvement in strength and sensation in the upper extremities. There were no post operative infections.
Conclusions: Laminectomy and Removal of accessible bullet fragments should be considered for patients with incomplete injuries or progressive neurological deficits.
Patient Care: Neurosurgeons will be more familiar with the literature on intradural migration of bullets and will better understand the possible benefits and indications of surgical retrieval of retained bullet fragments within the spinal canal.
Learning Objectives: By the conclusion of this session participants should be able to 1)Describe the benefits of surgical retrival of retained bullet fragments within the spinal canal. 2) Better determine which patients may benefit from surgical intervention. 3)Be aware of all of the cases in the literature on intradural migration of bullets