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Neurogenic claudication, a delayed complication of a retained bullet
J M Kuijlen1, M J Herpers, E A Beuls
1Department of Neurosurgery, University Hospital Maastricht, The Netherlands.
Spine
|April 15, 1997
Summary
Delayed neurologic deficits from retained bullets near the spine are rare but possible. Surgery is only recommended if neurological symptoms develop, as demonstrated in this case report of spinal bullet retention.
Area of Science:
- Neurosurgery
- Radiology
- Traumatology
Background:
- Retained bullets near the spinal cord can cause delayed neurological deficits due to chronic inflammatory reactions.
- Literature review reveals limited case reports on epidural inflammatory masses secondary to retained bullets.
Observation:
- A 31-year-old male presented with neurogenic claudication 11 years after a gunshot injury with a retained bullet.
- Radiographic evidence showed bullet disintegration and displacement, leading to intraspinal and extraspinal inflammation and cyst formation.
- A characteristic "fallen leaf sign" was observed on radiographs at the L5-S1 level.
Findings:
- The patient experienced pain radiating to both thighs, exacerbated by walking and standing.
- Surgical intervention was performed due to the development of neurological deficits.
- Postoperative follow-up at 1 year showed the absence of preoperative complaints.
Implications:
- The presence or absence of neurological symptoms should guide diagnostic and treatment decisions for retained bullets near the spinal canal.
- Surgical intervention should be considered only if a neurological deficit develops, with the decision based on deficit severity and type.
