Todnem Nathan, Hardigan Trevor, Banerjee Chris, Alleyne Cargill H
Department of Neurosurgery, Medical College of Georgia at Augusta University, Augusta, Georgia, USA.
Department of Neurosurgery, Medical College of Georgia at Augusta University, Augusta, Georgia, USA.
World Neurosurg. 2018 Nov;119:6-9. doi: 10.1016/j.wneu.2018.06.198. Epub 2018 Jul 20.
There are few reported instances of intraspinal migration of a bullet fragment. The majority of these migrations occur caudally, typically below the level of T10. Even fewer cases demonstrate cephalad migration from the sacral spine to the lumbar spine. We report here for the first time a case of a cephalad migration intradurally from the thoracic spine to cervical spine.
A 31-year old man presented to the emergency department with a suspected spinal cord injury following a GSW sustained to the left shoulder. A penetrating gunshot injury to the thoracic spine at the level of T2 was observed, and CT angiography revealed a cephalad migration of the bullet fragment to the level of C6. The patient had marked weakness of the bilateral upper extremities, with paraplegia of the lower extremities. There was a sensory deficit beginning at a level 1 cm below the clavicle, as well as a decrease in rectal tone. We performed a laminectomy at C6 with dural incision and removal of the main bullet fragment. Following the surgery, significant improvement in strength and sensation in the bilateral upper extremities was noted, but paraplegia and sensory loss below the level of T2 persisted.
In this report, we review the previously reported cases in which intraspinal migration of bullets have occurred, and discuss the unique finding in this study of cephalad migration of a bullet within the dura. In addition, we detail considerations in the management of such injuries.
子弹碎片在椎管内迁移的报道实例较少。这些迁移大多发生在尾侧，通常在T10水平以下。从骶椎向腰椎的头侧迁移的病例更是少之又少。我们在此首次报告一例子弹碎片在硬脊膜内从头侧的胸椎向颈椎迁移的病例。
一名31岁男性因左肩遭受枪伤被怀疑脊髓损伤而被送往急诊科。观察到T2水平的胸椎有穿透性枪伤，CT血管造影显示子弹碎片头侧迁移至C6水平。患者双侧上肢明显无力，下肢截瘫。在锁骨下方1厘米处开始有感觉障碍，直肠张力也下降。我们在C6进行了椎板切除术，切开硬脊膜并取出主要子弹碎片。手术后，双侧上肢的力量和感觉有显著改善，但T2水平以下的截瘫和感觉丧失仍然存在。
在本报告中，我们回顾了先前报道的子弹在椎管内迁移的病例，并讨论了本研究中子弹在硬脊膜内头侧迁移这一独特发现。此外，我们详细阐述了此类损伤处理中的注意事项。
