Lead toxicity and management of gunshot wounds in the lumbar spine

Rentfrow, Ben; Vaidya, Rahul; Elia, Chris; Sethi, Anil

doi:10.1007/s00586-013-2805-6

Cited by 29 publications

(24 citation statements)

References 10 publications

(11 reference statements)

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“…There are but a few case reports on lead toxicity with bullets or fragments in the spinal canal surrounded by cerebrospinal fluid, or from bullets in the disc space [44][45][46][47][48][49] ( Figure 4).…”

Section: Lead Toxicitymentioning

confidence: 99%

Civilian gunshot wounds of the spine: A literature review

Botha¹,

Booysen²,

Dunn³

2016

SA orthop. j.

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Section: Lead Toxicitymentioning

confidence: 99%

Civilian gunshot wounds of the spine: A literature review

Botha¹,

Booysen²,

Dunn³

2016

SA orthop. j.

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“…Neurosurgical procedures are not often required. 17,26 Surgical spinal decompression with bullet/ fragment removal may not be necessary when complete SCI is evident on physical examination. Surgery plays a major role in treatment of patients with spinal instability, who require immediate fixation and arthrodesis, with different types of instrumentation tailored for each case.…”

Section: Management Of Gswsmentioning

confidence: 99%

“…2,4,15 For decades, MR imaging has seldom been used for people with GSWs. 13,17,23 This is because of concerns about the magnetic field's effect on ferromagnetic bullet components that could potentially exacerbate the original injury. Therefore, GSWs have been considered a contraindication for MR imaging.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Magnetic resonance imaging in lumbar gunshot wounds: an absolute contraindication?

Martinez-del-Campo¹,

Rangel-Castilla²,

Soriano-Baron³

et al. 2014

FOC

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Object Performance of MR imaging in patients with gunshot wounds at or near the lumbar spinal canal is controversial. The authors reviewed the literature on the use of MR imaging in gunshot wounds to the spine. They discuss the results from in vitro and clinical studies, analyze the physical properties of common projectiles, and evaluate the safety and indications for MR imaging when metallic fragments are located near the spinal canal. Methods A review of the English-language literature was performed. Data from 25 articles were analyzed, including 5 in vitro studies of the interaction between 95 projectiles and the MR system's magnetic fields, and the clinical outcomes in 22 patients with metallic fragments at or near the spinal canal who underwent MR imaging. Results Properties of 95 civilian and military projectiles were analyzed at a magnet strength of 1, 1.5, 3, and 7 T. The most common projectiles were bullets with a core of lead, either with a copper jacket or unjacketed (73 [76.8%] of 95). Steel-containing (core or jacket) projectiles comprised 14.7%. No field interaction was evident in 78 (96.3%) of the 81 nonsteel projectiles. All steel projectiles showed at least positive deflection forces, longitudinal migration, or rotation. Heating of the projectiles was clinically insignificant. Image artifact was significant in all 9 steel bullets tested, but was not significant in 39 (88.6%) of the 44 nonsteel bullets tested. Overall, 22 patients with complete (82%) and incomplete (14%) spinal cord injury secondary to a projectile lodged inside the spinal canal underwent MR imaging. Discomfort and further physical or neurological deficits were not reported by any patient. Two patients with spinal cord injuries underwent MR imaging studies before surgical decompression and had subsequent, significant neurological improvement. Conclusions Metallic implants near or at the spinal canal are a relative contraindication for MR imaging. However, safe MR imaging might be feasible when a projectile's properties and a patient's individualized clinical presentation are considered.

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“…I read with interest this case report [1] describing late-onset plumbism associated with gunshot wound (GSW) to the spine, with retained lead-based bullet fragments within the intervertebral disc space. I congratulate the authors on their well-written, interesting, detailed, and accurate discussion of the literature pertaining to GSW involving the spine.…”

mentioning

confidence: 99%

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

2013

Eur Spine J

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Lead toxicity and management of gunshot wounds in the lumbar spine

Cited by 29 publications

References 10 publications

Civilian gunshot wounds of the spine: A literature review

Civilian gunshot wounds of the spine: A literature review

Magnetic resonance imaging in lumbar gunshot wounds: an absolute contraindication?

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)

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