title: Firearm bullet settling into the lumbar spinal canal without causing neurological deficit: A report of two cases.
abstract: BACKGROUND
  Uncertainty still exists regarding the treatment of the patients presenting with gunshot wounds to the spine. Neurological insults, cerebrospinal fluid fistula, infection, lead or copper toxicity, migration of bullets, and spinal instability are included among the common challenging issues.
  
  
  METHODS
  An 18-year-old woman was admitted with low back pain following a gunshot injury five days ago. She was neurologically intact. Radiological examinations showed that a bullet was settled in L4-5 disc space. The bullet was removed with a unilateral L4-5 partial hemilaminectomy and discectomy from the left side. The second case was of a 29-year-old man admitted with radiating leg pain on the right side following a gunshot injury from his left side of lower back four months ago. He had only positive straight leg raising test. Radiological studies showed two bullets, one was in the psoas muscle on the left side and the other was in spinal canal that had caused a burst fracture of the L5 vertebra. Following L5 laminectomy and bilateral L5-S1 facetectomy, the bullet was removed from the spinal canal and L5-S1 transpedicular posterior stabilization was performed. The postoperative period of both patients was unremarkable.
  
  
  CONCLUSIONS
  Bullet settling into the lumbar spinal canal without causing neurological deficit may require surgical intervention. Removal of bullets provided not only pain relief in both the cases but also prevented future complications such as migration of the bullets, plumbism, and neuropathic pain and instability.
authors.affiliation: Okan University, The Vocational School of Health Services, Tuzla, Istanbul, Turkey; Neurosurgery Clinic, Kurtkoy Ersoy Hospital, Istanbul, Turkey.
authors.forename: Tayfun
authors.initials: T
authors.lastname: Hakan
authors.affiliation: Neurosurgery Clinic, Kurtkoy Ersoy Hospital, Istanbul, Turkey.
authors.forename: Ajlan
authors.initials: A
authors.lastname: Çerçi
authors.affiliation: Orthopedic Clinic, Kurtkoy Ersoy Hospital, Istanbul, Turkey.
authors.forename: Serkan
authors.initials: S
authors.lastname: Gürcan
authors.affiliation: Orthopedic Clinic, Kurtkoy Ersoy Hospital, Istanbul, Turkey.
authors.forename: Serkan
authors.initials: S
authors.lastname: Akçay
keywords: Bullet; gunshot; penetrating spinal injury; retained bullet; spine; spine trauma