• Saad Ajmal, Syed Ather Enam, and Muhammad Shahzad Shamim.
• Section of Neurosurgery, Aga Khan University Hospital, P.O. Box 3500, Stadium Rd, Karachi 74800, Pakistan.
• Spine J. 2009 Oct 1; 9 (10): e5-8.

Background ContextFirearm injuries to the spine may cause injury to the neurological structures and/or to the spine, including ligaments and bones.PurposePatients usually present with symptoms immediately after injury. However, only a few cases have been reported where a patient is neurologically intact after the initial injury but develops deficits several months or years later. Almost all these cases develop delayed neurological deficit because of bullet migration.Study DesignCase report.MethodsA discussion, with a relevant review of the literature, the clinical histories, and radiological findings of two patients who experienced delayed neurological symptoms after gunshot wounds to the spine.ResultsOne patient presented after 14 years and the other after 5 months from the day of injury. Both cases are unique in that the delayed symptoms appeared because of formation of a reactive mass around the site of bullet impact. Lack of serial imaging studies is a barrier to the exclusion of bullet migration as an alternate cause of delayed symptoms.ConclusionThese cases illustrate that retained intraspinal bullets can present with delayed neurological findings secondary to reactive changes around the bullet.

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