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Vol. 34. Issue 1.
Pages 44-47 (January - February 2023)
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Vol. 34. Issue 1.
Pages 44-47 (January - February 2023)
Case Report
Minimally invasive retrieval of a bullet settling into the thoracic spinal canal in a pediatric patient: A case report
Recuperación mínimamente invasiva de una bala que se asienta en el canal espinal torácico en un paciente pediátrico: reporte de un caso
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Rami Darwazeha, Mazhar Darwazeha,
Corresponding author
, Mohammed Awad Elzainb, Rasha Al-Kanashc
a Department of Neurosurgery, Arab Women's Union Hospital, Nablus, Palestine
b Department of Neurosurgery, King Abdullah Hospital, Bisha, Saudi Arabia
c Endoscopic Spine Department, Razi Spine Clinic, Amman, Jordan
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Abstract

A 10-year-old boy presented to neurosurgery department after a gunshot wound to the upper thoracic spine. The bullet entered through the right deltoid muscle and lodged inside the spinal canal at T1 level. The patient arrived conscious and obeying commands; however, he experienced a loss of sensation below T3 level, loss of reflexes below the injured T1 level, loss of anal sphincter tone and paraplegia in the lower limbs (American Spinal Injury Association grade-A). Imaging studies revealed an intra-canalicular metallic bullet at the T1 level. The patient underwent urgent operation using a tubular retractor system and the microscope. Subsequently, the bullet was successfully retrieved. Postoperatively, the patient made a significant recovery and by the end of the 6th month, he was able to walk independently despite some gait instability. A minimally invasive approach for intra-canalicular bullet removal in the thoracic region is a safe and effective technique in pediatric patients.

Keywords:
Bullet
Case report
Gunshot
Intramedullary
Minimally invasive
Resumen

Un niño de 10 años se presentó al departamento de neurocirugía después de una herida de bala en la columna torácica superior. La bala entró por el músculo deltoides derecho y se alojó dentro del canal espinal a nivel T1. El paciente llegó consciente y obedeciendo órdenes; sin embargo, experimentó una pérdida de sensibilidad por debajo del nivel T3, pérdida de reflejos por debajo del nivel T1 lesionado, pérdida del tono del esfínter anal y paraplejía en las extremidades inferiores (American Spinal Injury Association grado-A). Los estudios de imagen revelaron una bala metálica intracanalicular a nivel T1. El paciente fue intervenido de urgencia mediante un sistema retractor tubular y el microscopio. Posteriormente, la bala se recuperó con éxito. En el postoperatorio, el paciente se recuperó significativamente y, al final del sexto mes, podía caminar de forma independiente a pesar de cierta inestabilidad en la marcha. Un enfoque mínimamente invasivo para la extracción de balas intracanaliculares en la región torácica es una técnica segura y eficaz en pacientes pediátricos.

Palabras clave:
Bala
Reporte de caso
Disparo
Intramedular
Mínimamente invasivo

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