de Los Cobos Daniel, Powers Alexa, Behrens Jonathan P, Mattei Tobias A, Salari Pooria
Departments of Orthopaedic Surgery and.
Neurosurgery, Saint Louis University School of Medicine, St. Louis, Missouri.
J Neurosurg Case Lessons. 2021 May 31;1(22):CASE21132. doi: 10.3171/CASE21132.
Management of gunshot wounds to the spine with subsequent spinal cord injury is a controversial topic among spine surgeons. Possible complications of retained intradural bullets include delayed neurological deficits, spinal instability, and lead toxicity. The authors' purpose is to review the potential complications of retained intraspinal bullets and the surgical indications for intraspinal bullet removal.
The authors describe a case of a patient who developed cauda equina symptoms following a gunshot wound to the lumbar spine with a migrating retained intraspinal bullet. Because of neurological changes, the patient underwent surgical removal of the bullet. At the postoperative clinic visit 2 weeks following bullet removal, the patient reported resolution of her symptoms.
Gunshot wounds to the spine are challenging cases. The decision to proceed with surgical management in the event of retained bullet fragments is multifactorial and relies heavily on the patient's neurological status. A current review of the literature suggests that, in cases of cauda equina injuries and the development of neurological deficits in patients with retained intraspinal fragments, there is benefit from surgical decompression and bullet removal. Careful preoperative planning is required, and consideration of spinal alignment with positional changes is crucial.
脊柱枪伤伴随后续脊髓损伤的管理在脊柱外科医生中是一个有争议的话题。硬膜内残留子弹的可能并发症包括延迟性神经功能缺损、脊柱不稳定和铅中毒。作者的目的是回顾脊柱内残留子弹的潜在并发症以及脊柱内子弹取出的手术指征。
作者描述了一例患者，该患者腰椎枪伤后出现马尾神经症状，有一枚移位的脊柱内残留子弹。由于神经功能改变，患者接受了子弹取出手术。在取出子弹后2周的术后门诊随访中，患者报告症状缓解。
脊柱枪伤是具有挑战性的病例。对于残留子弹碎片时是否进行手术治疗的决定是多因素的，并且很大程度上取决于患者的神经状态。当前的文献综述表明，在马尾神经损伤以及脊柱内残留碎片患者出现神经功能缺损的情况下，手术减压和子弹取出是有益的。需要进行仔细的术前规划，并且考虑体位改变时的脊柱对线情况至关重要。
