Vertebral bone destruction and cauda equina injury of the lumbar spinal canal due to gunshot wound: imaging findings with plain films, CT-myelography and MRI

María Luisa López-Acevedo; Ernesto Roldán-Valadez; Roberto Corona-Cedillo; Joaquín Hernández-Omaña; Óscar Suárez-Rivera; Manuel Martínez-López

2011, Number 4

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Med Sur 2011; 18 (4)

Vertebral bone destruction and cauda equina injury of the lumbar spinal canal due to gunshot wound: imaging findings with plain films, CT-myelography and MRI

López-Acevedo ML, Roldán-Valadez E, Corona-Cedillo R, Hernández-Omaña J, Suárez-Rivera Ó, Martínez-López M

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Language: English
References: 18
Page: 189-194
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ABSTRACT

Introduction. Penetrating wounds of the spine are the third most common cause of spinal cord and cauda equina injury. Gunshot wounds specifically, account for 13 to 17% of all spinal cord injuries every year. We present the imaging findings of a patient who sustained a gunshot injury to the lumbar spine evidenced by plains films, CT, CT-myelography and magnetic resonance imaging (MRI) with a brief review of the relevant literature. Case report. 47-year-old Mexican man was referred to our hospital after a gunshot wound to the lumbar spine. Plain films and CT depicted bone fragments and a bullet lodged in the spinal canal at L4-L5. The patient arrived to the emergency department and scheduled for surgery. Residual splinters and lumbar canal compression evidenced by CT-myelography allowed to schedule a second surgical procedure. Follow-up MR evaluation showed a dural patch placed over the dura with some epidural fluid collection causing residual compression of the cauda equina. No further surgical measures were required, the patient’s motor function improved to the point of assisted walking, sphincter damage remained unaltered. Discussion. Imaging evaluation comprises CT as the principal diagnostic allowing a precise localization of the bullet fragments within the spinal canal or vertebral segments. Use of MRI in assessing gunshot wounds to the spine is debated upon. With the rise of armed violence worldwide, it is essential for radiologists to have a clear understanding of gunshot injuries and their imaging evaluation, especially gunshot wounds to the spine that are the most problematic.

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