Operative Intervention for Lumbar Foraminal Gunshot Wounds: Case Report and Review of the Literature.

Cureus. 2019 Jul 29;11(7):e5269. doi: 10.7759/cureus.5269.

Brash A, Halalmeh DR, Rajah G, Loya J, Moisi M.

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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.

Copyright © 2019, Brash et al.

KEYWORDS:

bullet; gunshot wound; lumbar spine; treatment

Figure 1

Preoperative CT scans demonstrating a high-density foreign body in the left articular facet of L5 neural foramen

(A, B) axial and sagittal aspects showed fracture of the left L5 inferior facet (white arrows). No loss of vertebral body height or alignment. (A, C) axial and coronal aspects revealed comminuted blast fracture of the medial wing of the left iliac crest just superior to the left sacroiliac joint (black arrows), with no apparent joint destruction.

Figure 2

Intraoperative surgical view of the foreign body removal

Surgical microscopic view before (A) and after (B) removal of the foreign body. Foreign body (white arrow)

Figure 3

Intraoperative fluoroscopy demonstrating removal of the foreign body

Intraoperative fluoroscopy before (A) and after (B) removal of the foreign body.

Figure 4

Foreign body