Retained intraspinal bullet: a rare case in a visitor to malaysia - a case report.

Mh Ariffin,Azmi B,Noreen F,Shaharuddin Ar,Nor Hamdan Y

doi:10.5704/moj.1207.005

Abstract

Firearm injuries to the spine commonly present with acute neurology caused by direct penetration or indirectly from concussive effects of bullet impact on the vertebral column. We report a case of delayed neurologic presentation of retained intra-spinal bullet in a 42 year-old African who had chronic low back pain and sciatica with a past history of gunshot injury to the spine and radiograph revealed a bullet at the L4-5 disc level. Intra-operative exploration showed a fibrous mass around the bullet compressing on the L4 existing nerve root and L5 traversing nerve root. Removal of the retained bullet resulted in a good clinical outcome with complete resolution of symptoms. Intra-spinal bullet, gunshot injury.

Highlights

We present a case of delayed presentation of neurological deficit in a gunshot injury to the spine; such cases are rare and seldom reported in Malaysia
Acute cases of firearm injury are rare in Malaysia with only four acute cases of spine gun shot injury recorded in our institution over the past five years
Plain radiographs are invaluable in determining the level of the bullet, the location of the bullet with respect to the spinal and neural structures and evidence of fractures

Summary

INTRODUCTION

We present a case of delayed presentation of neurological deficit in a gunshot injury to the spine; such cases are rare and seldom reported in Malaysia. A 42-year-old African male presented with complaints of chronic low back pain with left leg radiculopathy. He disclosed a history of gunshot injury to the spine upon discovery of a back wound during clinical examination. Surgical removal of the retained bullet and adhesiolysis of the nerve compressed by the fibrous tissue resulted in complete resolution of the patient’s symptoms. The presentation of this rare case is highlighted to increase awareness among surgeons especially when treating patients from geographical areas where incidence of gun shot injury are high

CASE REPORT

DISCUSSION