Images in Neurosurgery

Figure 1: Sagittal CT demonstrating a bullet within the spinal canal at L3-L4 and in the vertebral body of S1.

Figure 2: Axial CT demonstrating the bullet within the spinal canal at L3-L4.

Figure 3: Intraoperative photograph demonstrating the bullet.

Figure 4: Intraoperative photograph demonstrating intact dura following extraction of the bullet.

Figure 5: The bullet removed from the spinal canal at L3-L4.

A 32-year-old police officer sustained three gunshot wounds. On examination, he demonstrated bilateral lower extremity weakness, right greater than left. Computed tomography (CT) imaging demonstrated a bullet lodged in the S1 vertebral body, and another bullet in the spinal canal at L3-L4. The patient was taken to the operating room for an L3-L4 laminectomy for removal of the foreign body. Rather remarkably, the bullet was completely extradural without dural or neural violation. The patient was discharged and lost to follow-up.

< Submitted by:
Katie L. Krause, MD, PhD; krausek@ohsu.edu
Khoi D. Than, MD; thank@ohsu.edu
Department of Neurological Surgery, Oregon Health & Science University