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• W1976974912 abstract "Gunshot wounds to the spine continue to be a prodigious clinical problem. We report a case of a 28-year-old male US Marine after a high-energy penetrating spinal cord injury, with associated injuries including a left hemopneumothorax and an open left comminuted scapula body fracture. Computed tomography demonstrated a retained highcaliber (7.62 mm) ballistic fragment within the spinal canal at the level of T6–T7 (Figs. 1 and 2). On physical examination, the patient had an incomplete spinal cord injury (American Spinal Injury Association Grade B) with sacral sparing demonstrating normal rectal tone, voluntary rectal squeeze, and bulbocavernosus reflex. The patient had 0/5 motor strength in bilateral lower extremities, normal sensation T6 right/T5 left, intact proprioception in bilateral ankles and toes, and normal strength/sensation in bilateral upper extremities. On Postinjury Day 5, the patient underwent a T6 laminectomy, removal of the bullet, and subsequent repair of a dural defect. This is the first case of a large caliber bullet being lodged in the spinal canal, with only a few reported case series of combat casualties treated for high-velocity ballistic injuries to the spinal column [1,2]. When treating gunshot wounds to the spine, it is of the utmost importance to differentiate between high- and low-energy ballistic injuries as this dictates the appropriate management [3]. Highenergy ballistic injuries are more common in combat casualties compared with civilian trauma patients and are often associated with significantly greater soft-tissue devitalization and a larger zone of injury. Treatment of high-energy ballistic injuries should consist of early broad-spectrum intravenous antibiotics, aggressive surgical debridement, and, when indicated, decompressive laminectomy with instrumentation at a Level 4 or 5 treatment facility. Fractures of the spine caused by low-velocity bullet wound or ballistic fragmentation are usually stable, and surgical intervention is often unnecessary. Most cases of spine instability and late deformity after penetrating injury have been associated with overly aggressive laminectomy [3,4]." @default.
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• W1976974912 date "2012-09-01" @default.
• W1976974912 modified "2023-09-27" @default.
• W1976974912 title "Large caliber ballistic fragment within the spinal canal" @default.
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• W1976974912 doi "https://doi.org/10.1016/j.spinee.2012.07.036" @default.
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