Expert’s comment concerning Grand Rounds case entitled “Lead toxicity and management of gunshot wounds in the lumbar spine” (by B. Rentfrow, R. Vaidya, C. Elia, A. Sethi doi:10.1007/s00586-013-2805-6)

Bellabarba, C.

doi:10.1007/s00586-013-2807-4

Cited by 2 publications

(1 citation statement)

References 7 publications

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“…[ 5 7 ] The bullet may show cranial migration in the spinal canal depending on the position of the victim; it may cause a change in neurological status and pain due to mechanical reactions. [ 1 ] Even though it is rare, the bullet fragment primarily located within an intervertebral disc space may cause plumbism[ 2 ] and back pain. [ 5 ] Reactive tissue formation and compression due to the retained bullet can cause progressive neuropathic pain.…”

Section: Discussionmentioning

confidence: 99%

Firearm bullet settling into the lumbar spinal canal without causing neurological deficit: A report of two cases

et al. 2016

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Background:Uncertainty still exists regarding the treatment of the patients presenting with gunshot wounds to the spine. Neurological insults, cerebrospinal fluid fistula, infection, lead or copper toxicity, migration of bullets, and spinal instability are included among the common challenging issues.Case Description:An 18-year-old woman was admitted with low back pain following a gunshot injury five days ago. She was neurologically intact. Radiological examinations showed that a bullet was settled in L4-5 disc space. The bullet was removed with a unilateral L4-5 partial hemilaminectomy and discectomy from the left side. The second case was of a 29-year-old man admitted with radiating leg pain on the right side following a gunshot injury from his left side of lower back four months ago. He had only positive straight leg raising test. Radiological studies showed two bullets, one was in the psoas muscle on the left side and the other was in spinal canal that had caused a burst fracture of the L5 vertebra. Following L5 laminectomy and bilateral L5-S1 facetectomy, the bullet was removed from the spinal canal and L5-S1 transpedicular posterior stabilization was performed. The postoperative period of both patients was unremarkable.Conclusion:Bullet settling into the lumbar spinal canal without causing neurological deficit may require surgical intervention. Removal of bullets provided not only pain relief in both the cases but also prevented future complications such as migration of the bullets, plumbism, and neuropathic pain and instability.

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