Retained Lumbar Intradural Bullet Fragment with Neurological Recovery after Delayed Removal of Bullet: Case Report and Literature Review

Abstract

Civilian gunshot wound (GSW) to the spine is expected to increase in our environment due to the recent surge in violence and firearm attacks in the  society either by herdsmen, bandits, unknown gunmen, or from exchange of gun fire with security personnel in response to insecurity issues. The  management of GSW in the spine remains controversial, with no clear recommendations for surgical intervention by spine surgeons. In light of this, we  report a case of civilian GSW  to the lumbar spine in a 47-year-old female with resultant immediate paraplegia. Neuroradiological studies revealed a large  bullet lodged in the left L2/3 spinal canal. There was a 4-week wait for consent for surgery to be obtained, with no improvement in motor function during  the period. She underwent laminectomy and duratomy with removal of the bullet. Motor function returned 3 weeks after the surgery, and she was  discharged home 8 weeks after the surgery, actively mobilizing on a Zimmer frame. The case report demonstrates the beneficial role of surgical  intervention in properly selected patients, with resultant satisfactory functional neurological recovery.