title: Lead toxicity and management of gunshot wounds in the lumbar spine.
abstract: BACKGROUND
  Gunshot wounds are one of the commonest causes of spinal injury. Management of these patients differs from other blunt trauma injuries to the spine. We present a case of a gunshot wound to the lumbar spine that occurred in 1985 which was treated non-operatively.
  
  
  METHODS
  In the last 10 years, the patient was admitted multiple times for confusion and lead toxicity with blood levels over 100 μg/dl. Inpatient chelation therapy was implemented. After multiple recommendations for surgery, the patient agreed to have as much of the bullet removed as possible. The patient successfully underwent decompression and fusion from both anterior and posterior approaches. Lead levels subsequently declined.
  
  
  CONCLUSIONS
  The purpose of this paper is to show a case of a gunshot wound to the spine that ultimately caused plumbism and required surgery. Technical aspects of the surgery are described as well as pre- and post-procedural imaging. Recommendations for the general management of spine gunshot wounds are also described.
authors.affiliation: Detroit Medical Center, Detroit Receiving Hospital, 4201 St Antoine Blvd, Detroit, MI, 48201, USA, Brentfro@dmc.org.
authors.forename: Ben
authors.initials: B
authors.lastname: Rentfrow
authors.forename: Rahul
authors.initials: R
authors.lastname: Vaidya
authors.forename: Chris
authors.initials: C
authors.lastname: Elia
authors.forename: Anil
authors.initials: A
authors.lastname: Sethi
mesh_terms: D019299:Decompression, Surgical; D006801:Humans; D007854:Lead / Q000097:blood; D007855:Lead Poisoning / Q000097:blood / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011859:Radiography; D013124:Spinal Injuries / Q000097:blood / Q000000981:diagnostic imaging / Q000601:surgery*; D014948:Wounds, Gunshot / Q000097:blood / Q000000981:diagnostic imaging / Q000601:surgery*
chemical_list: D007854:Lead