NDLI: Combat-Related Intradural Gunshot Wound to the Thoracic Spine: Significant Improvement and Neurologic Recovery Following Bullet Removal

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Combat-Related Intradural Gunshot Wound to the Thoracic Spine: Significant Improvement and Neurologic Recovery Following Bullet Removal

Content Provider	PubMed Central
Author	Louwes, Thijs M. Ward, William H. Lee, Kendall H. Freedman, Brett A.
Copyright Year	2015
Abstract	The vast majority of combat-related penetrating spinal injuries from gunshot wounds result in severe or complete neurological deficit. Treatment is based on neurological status, the presence of cerebrospinal fluid (CSF) fistulas, and local effects of any retained fragment(s). We present a case of a 46-year-old male who sustained a spinal gunshot injury from a 7.62-mm AK-47 round that became lodged within the subarachnoid space at T9-T10. He immediately suffered complete motor and sensory loss. By 24-48 hours post-injury, he had recovered lower extremity motor function fully but continued to have severe sensory loss (posterior cord syndrome). On post-injury day 2, he was evacuated from the combat theater and underwent a T9 laminectomy, extraction of the bullet, and dural laceration repair. At surgery, the traumatic durotomy was widened and the bullet, which was laying on the dorsal surface of the spinal cord, was removed. The dura was closed in a water-tight fashion and fibrin glue was applied. Postoperatively, the patient made a significant but incomplete neurological recovery. His stocking-pattern numbness and sub-umbilical searing dysthesia improved. The spinal canal was clear of the foreign body and he had no persistent CSF leak. Postoperative magnetic resonance imaging of the spine revealed contusion of the spinal cord at the T9 level. Early removal of an intra-canicular bullet in the setting of an incomplete spinal cord injury can lead to significant neurological recovery following even high-velocity and/or high-caliber gunshot wounds. However, this case does not speak to, and prior experience does not demonstrate, significant neurological benefit in the setting of a complete injury.
Related Links	http://dx.doi.org/10.4184/asj.2015.9.1.127
Starting Page	127
File Format	PDF
ISSN	19767846
e-ISSN	19767846
Journal	Asian Spine Journal
Issue Number	1
Volume Number	9
Language	English
Publisher	Korean Society of Spine Surgery
Publisher Date	2015-02-01
Access Restriction	Open
Rights Holder	Korean Society of Spine Surgery
Subject Keyword	Research in Higher Education
Content Type	Text
Resource Type	Article
Subject	Orthopedics and Sports Medicine Surgery

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