title: Long-term clinical manifestations of retained bullet fragments within the intervertebral disk space.
abstract: A retrospective review of 12 patients who were victims of penetrating trauma with a bullet or bullet fragments lodged within the intervertebral disk space was conducted. The objective of the review was to evaluate the potential systemic effects of lead resorption at long-term follow-up. Literature regarding the potential for lead toxicity due to retained bullet fragments within the intervertebral disk space is lacking. Between January 1969 and June 1993, a total of 238 patients with a gunshot wound to the spine were identified. Twelve of the 238 were found to have a bullet or bullet fragments within the intervertebral disk space. All patients were fully screened for evidence of plumbism. The average age at time of gunshot injury was 35.8 years; the average time for follow-up was 7.8 years. One of the 12 patients showed clinical evidence of plumbism. The patient subsequently underwent a partial laminectomy and diskectomy with excision of the bullet fragments. The patient's complaints, specific for plumbism, resolved 2 months postoperatively. We conclude that patients with retained lead-based bullet fragments in the intervertebral disk should be educated about the rare potential for plumbism due to partial bullet fragment resorption and that long-term observation for this disorder is recommended.
authors.affiliation: Parkway Regional Medical Center, North Miami Beach, Florida 33179, USA. scuderimd@aol.com
authors.forename: Gaetano J
authors.initials: GJ
authors.lastname: Scuderi
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Vaccaro
authors.forename: Laurence N
authors.initials: LN
authors.lastname: Fitzhenry
authors.forename: Steven
authors.initials: S
authors.lastname: Greenberg
authors.forename: Frank
authors.initials: F
authors.lastname: Eismont
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D005547:Foreign Bodies / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology; D006801:Humans; D007403:Intervertebral Disc / Q000000981:diagnostic imaging / Q000293:injuries*; D007855:Lead Poisoning / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D014505:Urban Population; D014948:Wounds, Gunshot / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology