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Alsabbagh Q, Kanaan T, Dumour EA, Hadidi F, Al-Sabbagh MQ. An incidental migrating intra-spinal bullet: the silent victim of celebratory gunfire. Br J Neurosurg 2023; 37:1358-1361. [PMID: 33063544 DOI: 10.1080/02688697.2020.1834505] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 10/06/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Incidentally found intra-spinal bullets are extremely rare, and have never been reported in the literature. The aim of this study is to report a rare case of an asymptomatic migrating intra-spinal bullet, emphasizing the role of cultural context in history taking, and describing its surgical retrieval technique. CASE PRESENTATION We discuss a case of a 10-years old boy with an incidentally discovered intra-spinal bullet opposite to the L5 vertebral level, who presented 3 months after the suspected initial insult. Following its migration to the L3/L4 level intraoperatively, the bullet was forced to spontaneously return to its preoperative position by reverse Trendelenburg Position, Valsalva maneuver and Intrathecal saline infusion, thus avoiding extending the previously performed laminectomy. CONCLUSION The authors remind the readers that history is the cornerstone of the clinical practice, even in the most obscure cases. Many convoluted intra-operative situations could be resolved by utilizing basic anatomical and physiological principles.
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Affiliation(s)
- Qussay Alsabbagh
- Division of neurological surgery, department of Special Surgery, The University of Jordan School of Medicine, Amman, Jordan
| | - Tareq Kanaan
- Division of neurological surgery, department of Special Surgery, The University of Jordan School of Medicine, Amman, Jordan
| | - Elias A Dumour
- Division of neurological surgery, department of Special Surgery, The University of Jordan School of Medicine, Amman, Jordan
| | - Fadi Hadidi
- Division of Orthopedics, department of Special Surgery, The University of Jordan School of Medicine, Amman, Jordan
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Ibebuike KE. Retained lumbar intradural bullet fragment with neurological recovery after delayed removal of bullet: Case report and literature review. Niger J Clin Pract 2023; 26:358-361. [PMID: 37056113 DOI: 10.4103/njcp.njcp_324_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
Civilian gunshot wound (GSW) to the spine is expected to increase in our environment due to the recent surge in violence and firearm attacks in the society either by herdsmen, bandits, unknown gunmen, or from exchange of gun fire with security personnel in response to insecurity issues. The management of GSW in the spine remains controversial, with no clear recommendations for surgical intervention by spine surgeons. In light of this, we report a case of civilian GSW to the lumbar spine in a 47-year-old female with resultant immediate paraplegia. Neuroradiological studies revealed a large bullet lodged in the left L2/3 spinal canal. There was a 4-week wait for consent for surgery to be obtained, with no improvement in motor function during the period. She underwent laminectomy and duratomy with removal of the bullet. Motor function returned 3 weeks after the surgery, and she was discharged home 8 weeks after the surgery, actively mobilizing on a Zimmer frame. The case report demonstrates the beneficial role of surgical intervention in properly selected patients, with resultant satisfactory functional neurological recovery.
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Affiliation(s)
- K E Ibebuike
- Division of Neurosurgery, Department of Surgery, Imo State University Teaching Hospital, Orlu, Imo State, Nigeria
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Baum GR, Baum JT, Hayward D, MacKay BJ. Gunshot Wounds: Ballistics, Pathology, and Treatment Recommendations, with a Focus on Retained Bullets. Orthop Res Rev 2022; 14:293-317. [PMID: 36090309 PMCID: PMC9462949 DOI: 10.2147/orr.s378278] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 08/16/2022] [Indexed: 02/05/2023] Open
Abstract
As the epidemic of gunshot injuries and firearm fatalities continues to proliferate in the United States, knowledge regarding gunshot wound (GSW) injury and management is increasingly relevant to health-care providers. Unfortunately, existing guidelines are largely outdated, written in a time that high-velocity weapons and deforming bullets were chiefly restricted to military use. Advances in firearm technology and increased accessibility of military grade firearms to civilians has exacerbated the nature of domestic GSW injury and complicated clinical decision-making, as these weapons are associated with increased tissue damage and often result in retained bullets. Currently, there is a lack of literature addressing recent advances in the field of projectile-related trauma, specifically injuries with retained bullets. This review aims to aggregate the available yet dispersed findings regarding ballistics, GSW etiology, and treatment, particularly for cases involving retained projectiles.
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Affiliation(s)
- Gracie R Baum
- Department of Orthopedic Hand Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Jaxon T Baum
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Dan Hayward
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Brendan J MacKay
- Department of Orthopedic Hand Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, USA,Correspondence: Brendan J MacKay, Department of Orthopedic Hand Surgery, Texas Tech University Health Sciences Center, 808 Joliet Ave Suite 310, Lubbock, TX, 79415, USA, Tel +1 806 743 4600, Email
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Williams S, Layard Horsfall H, Funnell JP, Hanrahan JG, Khan DZ, Muirhead W, Stoyanov D, Marcus HJ. Artificial Intelligence in Brain Tumour Surgery-An Emerging Paradigm. Cancers (Basel) 2021; 13:cancers13195010. [PMID: 34638495 PMCID: PMC8508169 DOI: 10.3390/cancers13195010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/02/2021] [Accepted: 10/03/2021] [Indexed: 01/01/2023] Open
Abstract
Artificial intelligence (AI) platforms have the potential to cause a paradigm shift in brain tumour surgery. Brain tumour surgery augmented with AI can result in safer and more effective treatment. In this review article, we explore the current and future role of AI in patients undergoing brain tumour surgery, including aiding diagnosis, optimising the surgical plan, providing support during the operation, and better predicting the prognosis. Finally, we discuss barriers to the successful clinical implementation, the ethical concerns, and we provide our perspective on how the field could be advanced.
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Affiliation(s)
- Simon Williams
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK; (H.L.H.); (J.P.F.); (J.G.H.); (D.Z.K.); (W.M.); (H.J.M.)
- Wellcome/Engineering and Physical Sciences Research Council (EPSRC) Centre for Interventional and Surgical Sciences (WEISS), London W1W 7TY, UK;
- Correspondence:
| | - Hugo Layard Horsfall
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK; (H.L.H.); (J.P.F.); (J.G.H.); (D.Z.K.); (W.M.); (H.J.M.)
- Wellcome/Engineering and Physical Sciences Research Council (EPSRC) Centre for Interventional and Surgical Sciences (WEISS), London W1W 7TY, UK;
| | - Jonathan P. Funnell
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK; (H.L.H.); (J.P.F.); (J.G.H.); (D.Z.K.); (W.M.); (H.J.M.)
- Wellcome/Engineering and Physical Sciences Research Council (EPSRC) Centre for Interventional and Surgical Sciences (WEISS), London W1W 7TY, UK;
| | - John G. Hanrahan
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK; (H.L.H.); (J.P.F.); (J.G.H.); (D.Z.K.); (W.M.); (H.J.M.)
- Wellcome/Engineering and Physical Sciences Research Council (EPSRC) Centre for Interventional and Surgical Sciences (WEISS), London W1W 7TY, UK;
| | - Danyal Z. Khan
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK; (H.L.H.); (J.P.F.); (J.G.H.); (D.Z.K.); (W.M.); (H.J.M.)
- Wellcome/Engineering and Physical Sciences Research Council (EPSRC) Centre for Interventional and Surgical Sciences (WEISS), London W1W 7TY, UK;
| | - William Muirhead
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK; (H.L.H.); (J.P.F.); (J.G.H.); (D.Z.K.); (W.M.); (H.J.M.)
- Wellcome/Engineering and Physical Sciences Research Council (EPSRC) Centre for Interventional and Surgical Sciences (WEISS), London W1W 7TY, UK;
| | - Danail Stoyanov
- Wellcome/Engineering and Physical Sciences Research Council (EPSRC) Centre for Interventional and Surgical Sciences (WEISS), London W1W 7TY, UK;
| | - Hani J. Marcus
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK; (H.L.H.); (J.P.F.); (J.G.H.); (D.Z.K.); (W.M.); (H.J.M.)
- Wellcome/Engineering and Physical Sciences Research Council (EPSRC) Centre for Interventional and Surgical Sciences (WEISS), London W1W 7TY, UK;
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5
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Zhong H, Wang B, Wang D, Liu Z, Xing C, Wu Y, Gao Q, Zhu S, Qu H, Jia Z, Qu Z, Ning G, Feng S. The application of machine learning algorithms in predicting the length of stay following femoral neck fracture. Int J Med Inform 2021; 155:104572. [PMID: 34547625 DOI: 10.1016/j.ijmedinf.2021.104572] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE Femoral neck fracture is a frequent cause of hospitalization, and length of stay is an important marker of hospital cost and quality of care provided. As an extension of traditional statistical methods, machine learning provides the possibility of accurately predicting the length of hospital stay. The aim of this paper is to retrospectively identify predictive factors of the length of hospital stay (LOS) and predict the postoperative LOS by using machine learning algorithms. METHOD Based on the admission and perioperative data of the patients, linear regression was used to analyze the predictive factors of the LOS. Multiple machine learning models were developed, and the performance of different models was compared. RESULT Stepwise linear regression showed that preoperative calcium level (P = 0.017) and preoperative lymphocyte percentage (P = 0.007), in addition to intraoperative bleeding (p = 0.041), glucose and sodium chloride infusion after surgery (P = 0.019), Charlson Comorbidity Index (p = 0.007) and BMI (P = 0.031), were significant predictors of LOS. The best performing model was the principal component regression (PCR) with an optimal MAE (1.525) and a proportion of prediction error within 3 days of 90.91%. CONCLUSION Excessive intravenous glucose and sodium chloride infusion after surgery, preoperative hypocalcemia, preoperative high percentages of lymphocytes, excessive intraoperative bleeding, lower BMI and higher CCI scores were related to prolonged LOS by using linear regression. Machine learning could accurately predict the postoperative LOS. This information allows hospital administrators to plan reasonable resource allocation to fulfill demand, leading to direct care quality improvement and more reasonable use of scarce resources.
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Affiliation(s)
- Hao Zhong
- International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord Injury, Department of Orthopedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, China
| | - Bingpu Wang
- State Key Laboratory of Precision Measurement Technology and Instrument, School of Precision Instruments and Optoelectronics Engineering, Tianjin University, Tianjin 300072, China
| | - Dawei Wang
- International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord Injury, Department of Orthopedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, China
| | | | - Cong Xing
- International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord Injury, Department of Orthopedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, China
| | - Yu Wu
- Department of Orthopedics, The First People's Hospital of Yichang, YiChang, Hubei Province, China
| | - Qiang Gao
- International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord Injury, Department of Orthopedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, China
| | - Shibo Zhu
- International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord Injury, Department of Orthopedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, China
| | - Haodong Qu
- International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord Injury, Department of Orthopedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, China
| | - Zeyu Jia
- International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord Injury, Department of Orthopedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, China
| | - Zhigang Qu
- College of electronic information and automation, Tianjin University of Science and Technology, Tianjin, China.
| | - Guangzhi Ning
- International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord Injury, Department of Orthopedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, China.
| | - Shiqing Feng
- International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord Injury, Department of Orthopedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, China.
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Karaeminogullari O, Ozer O. Percutaneous Transforaminal Endoscopic Removal of Spinal Shrapnel. World Neurosurg 2020; 142:179-183. [PMID: 32652273 DOI: 10.1016/j.wneu.2020.06.226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 06/29/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Gunshot injuries are one of the most common causes of the penetrating injuries of the spine. The victims of these injuries usually have neurologic deficits. Percutaneous endoscopic lumbar surgery is one of the most popular surgical spine interventions. We report a case with incomplete radiculopathy due to shrapnel located in L5 foramen that was removed by percutaneous endoscopic technique. CASE DESCRIPTION A 23-year-old man sustaining a gunshot injury penetrating to the abdomen presented to our hospital. His first examination revealed a single gunshot wound with entry hole in the left low lumbar region without exit hole and right lower abdominal quadrant tenderness. Plain radiographs and computed tomography showed a bullet in the abdomen and left L5 transverse process fracture and shrapnel in L5 foraminal zone. The bullet was removed by abdominal surgeons without any surgical plan for the shrapnel in the foramen. He was referred to our clinic 3 weeks after discharge. Without any further neurologic deterioration, he had uninterrupted severe pain that was mostly unbearable during the night. Despite gradually increasing dosages of different drugs, his pain relief was insufficient. Percutaneous transforaminal endoscopic removal of the shrapnel was planned. CONCLUSIONS Despite the absence of a universally approved algorithm in the treatment of spinal gunshot injuries, endoscopic technique can be kept in mind for a minimal access and invasiveness in case of indication for removal. With experience in endoscopic procedures and familiarity with surgical anatomy, the treatment of this unique case was completed successfully.
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Affiliation(s)
| | - Ozgur Ozer
- Department of Orthopaedics and Traumatology, Bayindir Hospital, Ankara, Turkey.
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Morare N, Moeng MS. Unusual case of a migrating spinal bullet: An opportunity for reflection. Trauma Case Rep 2020; 27:100301. [PMID: 32346596 PMCID: PMC7183229 DOI: 10.1016/j.tcr.2020.100301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2020] [Indexed: 11/19/2022] Open
Abstract
The following case report documents the presentation of a 28 year old male who presented to the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) trauma unit following a single gunshot wound to the spine. He presented walking, with no neurological dysfunction. On further investigation he was found to have a retained bullet at the L3 level of the spinal canal, which migrated within the canal from its initial point of entry. He was subsequently taken for a laminectomy and bullet removal under fluoroscopic guidance. Post operatively he was noted to have reduced proprioception bilaterally.
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Affiliation(s)
- Nolitha Morare
- Corresponding author at: Private Bag X39, Parktown, Johannesburg 2193, South Africa.
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Removal of Migrating Lumbar Spine Bullet: Case Report and Surgical Video. World Neurosurg 2019; 131:62-64. [PMID: 31356981 DOI: 10.1016/j.wneu.2019.07.151] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 07/18/2019] [Accepted: 07/19/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Gunshot wounds to the spine are devastating injuries. Rarely, the bullet has been reported to migrate. Migration is associated with progressive neurologic deficits that often improve with bullet removal. The authors report a case of removal of a migrating lumbar spine bullet. This is supplemented by an operative video and a review of the literature. CASE DESCRIPTION A 31-year-old man presented to the emergency department with multiple gunshot wounds and lower-extremity paresthesia. A ballistic injury occurred with an entry wound in the right posterior soft tissues, traversing the right paraspinal muscle and fracturing the left lumbar 5 pedicle and left lumbar 4 transverse process. The bullet was positioned within the spinal canal at the lumbar 3/4 interspace. His spinal injury was managed nonoperatively due to his traumatic injuries and findings of minimal neurologic deficit without cerebrospinal fluid leak. The patient returned to the neurosurgery clinic a year later and was found to have worsening low back pain, decreased sensation throughout the left leg, and radiating pain throughout the right leg. Imaging demonstrated the bullet had migrated caudally to the midlumbar 5 vertebral body. Given the patient's progressive symptoms and migration of the bullet fragment, informed consent was obtained for a laminectomy and removal of the intradural bullet fragment. CONCLUSIONS Neurosurgical treatment for gunshot wounds remains controversial. Cauda equina or lumbosacral level wounds are often incomplete and may improve with surgical decompression and bullet removal. Migrating bullet fragments throughout the spine and brain lead to worsened neurologic function, which can be reversed by removal. Movement of the bullet during surgery should be expected, and intraoperative fluoroscopy and patient positioning can help to properly localize the bullet and aid in its removal.
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Brash A, Halalmeh DR, Rajah G, Loya J, Moisi M. Operative Intervention for Lumbar Foraminal Gunshot Wounds: Case Report and Review of the Literature. Cureus 2019; 11:e5269. [PMID: 31576262 PMCID: PMC6764617 DOI: 10.7759/cureus.5269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Gunshot wounds represent the second most frequent cause of spinal cord injury after vehicular trauma. The thoracic region is most commonly involved, followed by the thoracolumbar spine. Numerous studies have demonstrated that improvement of neurological recovery, especially after decompression surgery, is likely to be seen in lumbosacral spine, but not in the thoracic or cervical spine. Herein, we present a case of a gunshot wound causing lumbar 5th nerve root compression with neurological deficits that improved remarkably after urgent decompression surgery. This signifies a potential neurological benefit to prompt surgical intervention in lumbar gunshot wounds with radiographic evidence of neural compression. A relevant review of the literature was performed along with discussion, the clinical history, and radiological findings.
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Affiliation(s)
- Andrew Brash
- Neurosurgery, Stony Brook University, New York, USA
| | | | - Gary Rajah
- Neurosurgery, Wayne State University School of Medicine, Detroit, USA
| | - Joshua Loya
- Neurosurgery, Wayne State University School of Medicine, Detroit, USA
| | - Marc Moisi
- Neurosurgery, Seattle Science Foundation, Seattle, USA
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10
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Machine Learning and Neurosurgical Outcome Prediction: A Systematic Review. World Neurosurg 2018; 109:476-486.e1. [DOI: 10.1016/j.wneu.2017.09.149] [Citation(s) in RCA: 217] [Impact Index Per Article: 36.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 09/20/2017] [Accepted: 09/21/2017] [Indexed: 11/18/2022]
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Baldawa S, Shivpuje V. Migratory low velocity intradural lumbosacral spinal bullet causing cauda equina syndrome: report of a case and review of literature. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 26:128-135. [PMID: 27942941 DOI: 10.1007/s00586-016-4913-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 10/02/2016] [Accepted: 12/04/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Migration of the bullet within the spinal subarachnoid space has long been recognized as unusual complication of spinal gunshot injury. OBJECTIVE We report a case of migratory low velocity intradural lumbosacral spinal bullet causing cauda equina syndrome. The relevant literature is reviewed and all cases of migratory spinal bullet are summarised, and management strategies are discussed. STUDY DESIGN Literature review. METHODS A 32-year-old male suffered abdominal gunshot injury for which emergency laparotomy and repair of colonic perforation were performed. The bullet was seen lodged within the sacral spinal canal behind the S1 vertebral body. The probable entry point was at L2-L3 level. Caudal migration of the bullet within the spinal subarachnoid space leads to the appearance of cauda equina syndrome. RESULTS Bullet was retrieved following upper sacral and lower lumbar laminectomy. Prone positioning of the patient had lead to cranial migration of the bullet at L4 level which was confirmed on fluoroscopy. Laminectomy had to be extended upwards with the patient in reverse Trendelenburg position for bullet removal. CONCLUSIONS Caudal migration of the bullet within the lumbosacral subarachnoid space results in cauda equina syndrome. Surgical retrieval of the bullet ensures the early recovery of neurological symptoms. Prone patient positioning can influence bullet location. Intraoperative fluoroscopy prior to skin incision is essential in addition to preoperative imaging to locate the bullet and thus avoid incorrect lower level laminectomy. Trapping the bullet after durotomy using suction and dissector in reverse Trendelenburg position is a useful aid in bullet removal.
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Affiliation(s)
- Sachin Baldawa
- Department of Neurosurgery, Yashodhara Superspeciality Hospital, Solapur, Maharashtra, India. .,Department of Neurosurgery, Baldawa Hospital, Budhwar Peth, Solapur, 413002, Maharashtra, India.
| | - Vijay Shivpuje
- Department of General Surgery, Yashodhara Superspeciality Hospital, Solapur, Maharashtra, India
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