Lomber İntradural Yerleşimli Mermi Çekirdeğinin Yer Değiştirmesi ve Cerrahi Tedavisi
Özet
Spinal ateşli silah yaralanmaları, geniş bir klinik spektrumda ciddi sonuçlara yol açabilir. Bu çalışmada, lomber bölgedeki intradural bir mermi çekirdeğinin, ateşli silah yaralanması sonrası zamanla semptomatik hale geldiği bir olgu sunulmuştur. Mermi çekirdeğinin hareketliliği ve cerrahi sırasında yer değiştirme olasılığı, bu tür vakaların tedavisinde dikkate alınması gereken önemli bir faktördür. Olgumuzda, cerrahi müdahale sırasında artmış lordoz nedeniyle mermi çekirdeğinin kraniale doğru yer değiştirdiği gözlenmiştir. İnkomplet yaralanmaların iyileşme potansiyeline sahip olması nedeniyle, bu tür vakalarda cerrahi tedavi değerlendirilmeli, mermi çekirdeğinin hareketliliği cerrahi başarı açısından göz önünde bulundurulmalıdır.
Spinal gunshot injuries can lead to severe outcomes across a broad clinical spectrum. This study presents a case where an intradural bullet fragment in the lumbar region became symptomatic over time following a gunshot injury. The mobility of the bullet and the possibility of its displacement during surgery are crucial factors to consider in the treatment of such cases. In our case, the bullet was observed to move cranially during surgical intervention due to increased lordosis. Given the potential for recovery in incomplete injuries, surgical treatment should be carefully considered, with particular attention to the mobility of the bullet to ensure surgical success.
Referanslar
National Spinal Cord Injury Statistical Center, University of Alabama at Birmingham. 2019 Annual Statistical Report—Complete Public Version. National Spinal Cord Injury Statistical Center, University of Alabama at Birmingham;
Kitchel SH. Current treatment of gunshot wounds to the spine. Clin Orthop Relat Res. 2003;(408):115–119.
de Barros Filho TE, Cristante AF, Marcon RM, Ono A, Bilhar R. Gunshot injuries in the spine. Spinal Cord. 2014;52(7):504-510. doi:10.1038/sc.2014.56
Sidhu GS, Ghag A, Prokuski V, Vaccaro AR, Radcliff KE. Civilian gunshot injuries of the spinal cord: a systematic review of the current literature. Clin Orthop. 2013;471:3945-3955.
Bumpass DB, Buchowski JM, Park A, et al. An update on civilian spinal gunshot wounds: treatment, neurological recovery, and complications. Spine (Phila Pa 1976). 2015;40(7):450-461. doi:10.1097/BRS.0000000000000797
de Los Cobos D, Powers A, Behrens JP, Mattei TA, Salari P. Surgical removal of a migrating intraspinal bullet: illustrative case. J Neurosurg Case Lessons. 2021;1(22):CASE21132. Published 2021 May 31. doi:10.3171/CASE21132
Siddiqui MI, Hawksworth SA, Sun DY. Removal of Migrating Lumbar Spine Bullet: Case Report and Surgical Video. World Neurosurg. 2019;131:62-64. doi:10.1016/j.wneu.2019.07.151
Baldawa S, Shivpuje V. Migratory low velocity intradural lumbosacral spinal bullet causing cauda equina syndrome: report of a case and review of literature. Eur Spine J. 2017;26(Suppl 1):128-135. doi:10.1007/s00586-016-4913-6
Genç A, Usseli MI, Necmettin Pamir M. When the bullet moves! Surgical caveats from a migrant intraspinal bullet. Neurol Neurochir Pol. 2016;50(5):387-391. doi:10.1016/j.pjnns.2016.06.006
Ghori SA, Khan MS, Bawany FI. Delayed Cauda Equina syndrome due to a migratory bullet. J Coll Physicians Surg Pak. 2014;24 Suppl 3:S219-S220.
Dong, C., Kershner, E., Zuelzer, W.A., Smith, M.S., Hasan, K. (2024). Lead Toxicity Due to Retained Bullet Fragments. In: Zuelzer, W.A., Metikala, S. (eds) Unusual Conditions That Every Orthopaedic Surgeon Should Know. Springer, Cham. https://doi.org/10.1007/978-3-031-58946-1_11
Waters RL, Adkins RH. The effects of removal of bullet fragments retained in the spinal canal. Spine (Phila Pa 1976). 1991. 16: 934-9
Bustamante ND, Macias-Konstantopoulos WL. Retained Lumbar Bullet: A Case Report of Chronic Lead Toxicity and Review of the Literature. J Emerg Med. 2016;51(1):45-49. doi:10.1016/j.jemermed.2016.02.025
de Araújo GC, Mourão NT, Pinheiro IN, Xavier AR, Gameiro VS. Lead Toxicity Risks in Gunshot Victims. PLoS One. 2015;10(10):e0140220. Published 2015 Oct 28. doi:10.1371/journal.pone.0140220
Baldawa S, Shivpuje V. Migratory low velocity intradural lumbosacral spinal bullet causing cauda equina syndrome: report of a case and review of literature. Eur Spine J. 2017;26(Suppl 1):128-135. doi:10.1007/s00586-016-4913-6
Referanslar
National Spinal Cord Injury Statistical Center, University of Alabama at Birmingham. 2019 Annual Statistical Report—Complete Public Version. National Spinal Cord Injury Statistical Center, University of Alabama at Birmingham;
Kitchel SH. Current treatment of gunshot wounds to the spine. Clin Orthop Relat Res. 2003;(408):115–119.
de Barros Filho TE, Cristante AF, Marcon RM, Ono A, Bilhar R. Gunshot injuries in the spine. Spinal Cord. 2014;52(7):504-510. doi:10.1038/sc.2014.56
Sidhu GS, Ghag A, Prokuski V, Vaccaro AR, Radcliff KE. Civilian gunshot injuries of the spinal cord: a systematic review of the current literature. Clin Orthop. 2013;471:3945-3955.
Bumpass DB, Buchowski JM, Park A, et al. An update on civilian spinal gunshot wounds: treatment, neurological recovery, and complications. Spine (Phila Pa 1976). 2015;40(7):450-461. doi:10.1097/BRS.0000000000000797
de Los Cobos D, Powers A, Behrens JP, Mattei TA, Salari P. Surgical removal of a migrating intraspinal bullet: illustrative case. J Neurosurg Case Lessons. 2021;1(22):CASE21132. Published 2021 May 31. doi:10.3171/CASE21132
Siddiqui MI, Hawksworth SA, Sun DY. Removal of Migrating Lumbar Spine Bullet: Case Report and Surgical Video. World Neurosurg. 2019;131:62-64. doi:10.1016/j.wneu.2019.07.151
Baldawa S, Shivpuje V. Migratory low velocity intradural lumbosacral spinal bullet causing cauda equina syndrome: report of a case and review of literature. Eur Spine J. 2017;26(Suppl 1):128-135. doi:10.1007/s00586-016-4913-6
Genç A, Usseli MI, Necmettin Pamir M. When the bullet moves! Surgical caveats from a migrant intraspinal bullet. Neurol Neurochir Pol. 2016;50(5):387-391. doi:10.1016/j.pjnns.2016.06.006
Ghori SA, Khan MS, Bawany FI. Delayed Cauda Equina syndrome due to a migratory bullet. J Coll Physicians Surg Pak. 2014;24 Suppl 3:S219-S220.
Dong, C., Kershner, E., Zuelzer, W.A., Smith, M.S., Hasan, K. (2024). Lead Toxicity Due to Retained Bullet Fragments. In: Zuelzer, W.A., Metikala, S. (eds) Unusual Conditions That Every Orthopaedic Surgeon Should Know. Springer, Cham. https://doi.org/10.1007/978-3-031-58946-1_11
Waters RL, Adkins RH. The effects of removal of bullet fragments retained in the spinal canal. Spine (Phila Pa 1976). 1991. 16: 934-9
Bustamante ND, Macias-Konstantopoulos WL. Retained Lumbar Bullet: A Case Report of Chronic Lead Toxicity and Review of the Literature. J Emerg Med. 2016;51(1):45-49. doi:10.1016/j.jemermed.2016.02.025
de Araújo GC, Mourão NT, Pinheiro IN, Xavier AR, Gameiro VS. Lead Toxicity Risks in Gunshot Victims. PLoS One. 2015;10(10):e0140220. Published 2015 Oct 28. doi:10.1371/journal.pone.0140220
Baldawa S, Shivpuje V. Migratory low velocity intradural lumbosacral spinal bullet causing cauda equina syndrome: report of a case and review of literature. Eur Spine J. 2017;26(Suppl 1):128-135. doi:10.1007/s00586-016-4913-6
