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The path of a wounding missile along the spinal canal: a case report
1Department of Neurosurgery, University Medical Centre, Ljubljana, Slovenia.
Study Design:
The authors report a penetrating gunshot injury to the cervical spine at the C6 level, with retention of the missile within the spinal canal at the T10 level.
Objectives:
The treatment of this patient involved debridement of entrance wound on the day of admission and laminectomies in the cervical and thoracic levels 3 days after the incident.
Summary Of Background Data:
The migration of a foreign body along the intracranial part of the central nervous system has been reported in the literature, but we have found no report of an intercanal gunshot wound measuring 30 cm with complete liquefaction of the cord.
Methods:
On admission, a 21-year-old man had an entrance wound on the right side of neck. He had complete paraplegia and could not flex the wrist. The cervical spine radiograph revealed a fracture of the C5 arch and metallic fragments in the spinal canal. A radiograph of the thoracic and lumbar spine disclosed a bullet trapped at the T10 level. Laminectomies at C6-C7 and T9-T10 were performed and the bullet and its fragments were removed. The ruptured dura was replaced by lyophilized dura.
Results:
The wounds healed without infection. On discharges the patient's neurologic status was unchanged.
Conclusions:
Laminectomies and removal of metallic foreign bodies were performed to reduce the risk of infection in the spinal canal and to prevent toxic effects of dissolved metals on uninjured parts of the central nervous system.