title: Migration of a bullet in the spinal canal.
abstract: Migration of a bullet within the spinal canal after gunshot injury is rare. We report here the case of a penetrating gunshot injury of the lumbar spine at L3 with migration of the bullet within the spinal canal S2. The patient had marked paraparesis (proximal 1/5, distal 0/5 muscle strength) and anaesthesia at L3 and below, and had a hypocompliant, hyper-reflexive bladder with decreased capacity, and absent anal tonus. We removed osseous fragments in the canal with an L3 laminectomy and extracted the bullet by S2 laminectomy. After surgery, we observed an improvement in paraparesis, an increase in bladder capacity and urinary compliance, and improvement in anal tonus. The appropriate course of action in this type of injury remains unclear, because the number of cases described in the literature is not sufficient to provide a basis on which to make a definitive therapeutic decision. We herein review the literature describing cases in which a bullet in the spinal canal has migrated; we describe the treatment used and the outcomes in these cases.
authors.affiliation: Department of Neurosurgery, Zonguldak Karaelmas University, TiP Fakültes, Hastanesi Nöroşirurji AD, Zonguldak 67600, Turkey. cagavif@yahoo.com
authors.forename: Ferda
authors.initials: F
authors.lastname: Cağavi
authors.forename: Murat
authors.initials: M
authors.lastname: Kalayci
authors.forename: Ilker
authors.initials: I
authors.lastname: Seçkiner
authors.forename: Zeynep
authors.initials: Z
authors.lastname: Cağavi
authors.forename: Sanser
authors.initials: S
authors.lastname: Gül
authors.forename: Hüseyin Tuğrul
authors.initials: HT
authors.lastname: Atasoy
authors.forename: Nejat
authors.initials: N
authors.lastname: Demircan
authors.forename: Bektaş
authors.initials: B
authors.lastname: Açikgöz
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000502:physiology; D005548:Foreign-Body Migration / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D008297:Male; D020335:Paraparesis / Q000209:etiology; D013131:Spine / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed; D014563:Urodynamics / Q000502:physiology; D014948:Wounds, Gunshot / Q000150:complications*