Doble lesión de la médula espinal por proyectil de arma de fuego con migración en el canal medular: reporte de un caso

Ana Xiomara Cortés-Neira; Sebastián Andrés Torres-Vera; Fernando Torres-Romero

doi:10.58814/01208845.11

Authors

Ana Xiomara Cortés-Neira Universidad Nacional de Colombia, Specialty in Orthopedics and Trauma, Bogotá D.C., Colombia. https://orcid.org/0000-0003-1876-9267
Sebastián Andrés Torres-Vera Universidad Nacional de Colombia, Specialty in Orthopedics and Trauma, Bogotá D.C., Colombia. https://orcid.org/0000-0002-5067-3751
Fernando Torres-Romero Hospital Universitario Nacional de Colombia, Orthopedics and Trauma Service, Bogotá D.C., Colombia. | Hospital El Tunal, Orthopedics and Trauma Service, Bogotá D.C., Colombia. https://orcid.org/0000-0003-4987-6962

DOI:

https://doi.org/10.58814/01208845.11

Keywords:

Wounds, Gunshot, Spinal Cord Injuries, Neurologic Manifestations, Spine, Surgery

Abstract

Introduction: Surgical treatment of spinal gunshot wounds is controversial, however, neurological deficit is one of the criteria for its indication.

Case presentation: A 21-year-old man was admitted to the emergency department of a tertiary care hospital in Bogotá, Colombia, due to multiple gunshot wounds, paraplegia, hypoesthesia in the lower limbs and saddle area, and inability to move, for which thoracotomy and laparotomy were performed. Given the absence of muscle strength and reflexes, a grade A spinal cord injury was diagnosed according to the American Spinal Injury Association Impairment Scale (ASIA). Twelve hours after admission, the patient was taken to surgery for the removal of a firearm projectile (laminectomy and longitudinal durotomy) without achieving the extraction, so a fluoroscopy was carried out, in which it was observed that the bullet had migrated cephalad to the L4-L5 intervertebral space. L4-L5 laminectomy, dural sac exposure, and longitudinal durotomy were performed, leading to the removal of the projectile. After 20 days, improvement of motor function and muscle strength, voluntary contraction of quadriceps, and grade C in ASIA were reported.

Conclusion: Projectile removal in spinal cord injuries is recommended when the projectile migrates into the spinal canal. Fluoroscopy is recommended before and after surgery.

Downloads

Download data is not yet available.

References

Jaiswal M, Mittal RS. Concept of Gunshot Wound Spine. Asian Spine J. 2013;7(4):359-64. https://doi.org/gb94x4.

Sajid MI, Ahmad B, Mahmood SD, Darbar A. Gunshot injury to spine: An institutional experience of management and complications from a developing country. Chin J Traumatol. 2020;23(6):324-8. https://doi.org/jt66.

Aljuboori Z. Surgical removal of a spinal intrathecal projectile led to a significant improvement of cauda equina syndrome. Surg Neurol Int. 2020;11:227.https://doi.org/jt67.

Patil R, Jaiswal G, Gupta TK. Gunshot wound causing complete spinal cord injury without mechanical violation of spinal axis: Case report with review of literature. J Craniovertebr Junction Spine 2015;6(4):149-57. https://doi.org/jt69.

Bassani R, Morselli C, Agnoletto M, Brambilla L, Peretti GM. Management of gunshot wound to the lumbosacral spine in a 17-year-old girl without neurological impairment. J Biol Regul Homeost Agents. 2020;34(4 Suppl. 3):1-5.

Oktem IS, Selçuklu A, Kurtsoy A, Kavuncu IA, Paşaoğlu A. Migration of bullet in the spinal canal: a case report. Surg Neurol 1995;44:548-50. https://doi.org/czd5tt.

Rajan DK, Alcantara AL, Michael DB. Where’s the bullet? A migration in two acts. J Trauma 1997;43(4):716–8. https://doi.org/bd6m4h.

Morare N, Moeng MS. Unusual case of a migrating spinal bullet: An opportunity for reflection. Trauma Case Rep. 2020;27:100301. https://doi.org/jt7b.

Jun W, Yi-Jun K, Xiang-Sheng Z, Jing W. Cauda equina syndrome caused by a migrated bullet in dural sac. Turk Neurosurg. 2010;20(4):566-9. https://doi.org/d3tmp9.

Chan YT, Al-Mahfoudh R, Thennakon S, Eldridge P, Pillay R. Migrating intrathecal high-velocity projectile. Br J Neurosurg 2015;29(4):585-6. https://doi.org/jt7c.

Bordon G, Burguet Girona S. Gunshot wound in lumbar spine with intradural location of a bullet. Case Rep Orthop 2014;2014:698585. https://doi.org/gb9849.

Harsha KJ, Thomas A. Penetrating Injury to Cauda Equina from a Missile Fragment, Completely Recovered after Delayed Surgical Removal of Ballistic Fragment. Asian J Neurosurg. 2018;13(2):433-5. https://doi.org/gdfbxp.

Morrow KD, Podet AG, Spinelli CP, Lasseigne LM, Crutcher CL, Wilson JD,et al.. A case series of penetrating spinal trauma: comparisons to blunt trauma, surgical indications, and outcomes. Neurosurg Focus. 2019;46(3):E4. https://doi.org/jt7d.

Ryu B, Kim SB, Choi MK, Kim KD. Radiculopathy as delayed presentations of retained spinal bullet. J Korean Neurosurg Soc. 2015;58(4):393-6. https://doi.org/jt7f.

Todnem N, Hardigan T, Banerjee C, Alleyne CH Jr. Cephalad Migration of Intradural Bullet from Thoracic Spine to Cervical Spine. World Neurosurg. 2018;119:6-9. https://doi.org/gfmfvf.

Young WF Jr, Katz MR, Rosenwasser RH. Spontaneous migration of an intracranial bullet into the cervical canal. South Med J. 1993;86(5):557–9. https://doi.org/fsgz4b.

Ojukwu DI, Beutler T, Goulart CR, Galgano M. Bullet retrieval from the cauda equina after penetrating spinal injury: A case report and review of the literature. Surg Neurol Int. 2021;12:163. https://doi.org/jt7g.

Ghori SA, Khan MS, Bawany FI. Delayed cauda equina syndrome due to a migratory bullet. J Coll Physicians Surg Pak. 2014;24(Suppl 3):S219-20.

Baldawa S, Shivpuje V. Migratory low velocity intradural lumbosacral spinal bullet causing cauda equina syndrome: report of a case and review of literature. Eur Spine J. 2017;26(Suppl 1):128-35. https://doi.org/gbp3z6.

Siddiqui MI, Hawksworth SA, Sun DY. Removal of Migrating Lumbar Spine Bullet: Case Report and Surgical Video. World Neurosurg 2019;131:62-4. https://doi.org/jt7h.