• Anouar Bourghli, Safwat Abouhashem, Rami Abo Wali, Ibrahim Obeid, Louis Boissiere, Jean-Marc Vital, and Mohammed Al Sarawan.
• Orthopedic and Spinal Surgery Department, Kingdom Hospital, P. O. Box 84400, Riyadh, 11671, Saudi Arabia. anouar.bourghli@gmail.com.
• Eur Spine J. 2018 Aug 1; 27 (8): 1681-1687.

PurposeGunshot injury to the spine can be devastating, and it has increased in the civilian population during the last decade.MethodsWe present the case of a 30-year-old male, who received a bullet in his back after exchange of fire with the police. Initial assessment revealed paraparesis with cerebrospinal fluid leak (CSF) from the bullet entry hole, CT scan showed metal debris with two bullet fragments in the L5/S1 right foramen and lateral recess, and another fragment in the central canal posteriorly, and also it revealed two fracture lines creating a right L5 "floating pedicle".ResultsThe patient was taken to the operating room and underwent L5/S1 posterior approach with right L5 pedicle stabilization with a pedicle screw, removal of the bullet fragments, dural repair with a patch, L5/S1 posterolateral fusion, and insertion of a lumbar CSF drain. The patient could walk with a walking frame on day 7 with a satisfactory radiological result at 1 year but with a remaining partial motor deficit of both ankles, mainly on the right side.ConclusionLiterature contains a lot of controversies regarding the management of spinal gunshot injuries. The current case shows that early surgical management, when partial neurological deficit with a CSF leak is noted, could improve the clinical outcome and prevent related complications.

27 keywords...

hide…