INTRADURAL EXTRAMEDULLARY LEAD INJURY: A CASE REPORT

Year 2011, Volume: 2 Issue: 7, - , 03.03.2015

Mustafa Aras , M. Altaş Cem Zeren Hanifi Bayaroğulları G. Çavuş

Abstract

The incidence of a spinal cord injury from gunshot wounds in penetrating trauma continues to increase with the violent nature of society. The aim of this article is to present one case of penetrating gunshot injuries to the lumbar spine and discuss the necessity of early surgery and physical therapy. Case, male 35 years old. Hospitalized due to gunshot wounds and from the waist and feet of inactivity. There were bullet entry hole in the patient's flank region and entry - exit wound in his right leg and the patient had paraplegia. After the L2 total laminectomy and
flavectomy the dura was removed under a microscope and intradural localized bullet removed. There was no bone defect on radiological studies, and during the surgery. It was remarkable. In our case, surgery was performed immediately after the injury and postoperative physical therapy was performed early. In Postoperative follow-up neurological improvement was observed. On examination 2 months after the surgery his motor deficit was improved to 2/5 muscle strength on left leg extremities, and 3/5 muscle strength on right leg extremities. As a result, early physical therapy in such patients after early surgical remove, the healing process provide be faster.  

İNTRADURAL EKSTRAMEDÜLLER KURŞUN YARALANMASI: OLGU SUNUMU

Abstract

Omuriliğin penetran travmaları, günümüzde savaşların ve şiddet olaylarının artışına paralel olarak önemini hala korumaktadır. Bu çalışmada spinal ateşli silah yaralanması olan bir olguda erken dönemde cerrahi ve fizik tedavinin gerekliliğinin tartışılması amaçlandı. Olgu, erkek 35 yaşındaydı. Belinden ateşli silah yaralanması ve ayaklarda hareketsizlik nedeni ile yatırıldı. Flank bölgesinde kurşun giriş ve sağ bacağında kurşun giriş-çıkış yarası olan hastada parapleji mevcuttu. L2 total laminektomi ve flavektomiden sonra mikroskop altında dura açılarak intradural yerleşimli kurşun çıkarıldı. Cerrahi sırasında kurşun giriş yerinde kemik defekti gözlenmedi. Postop lomber eksternal drenaj sistemi yerleştirildi. Postop erken dönemde nörolojik durumunda değişiklik olmadı. Olgumuzda da yaralanmadan hemen sonrasında cerrahi müdahale yapıldı ve postop erken dönem fizik tedavi uygulandı. Postop takiplerinde nörolojik durumunda düzelme olduğu gözlendi. Ameliyattan 2 ay sonraki kontrol muayenesinde sol alt ekstremite 2/5 motor kuvvette, sağ alt ekstremite 3/5 motor kuvvette tespit edildi. Sonuç olarak, erken cerrahi müdahaleden sonra erken dönemde fizik tedavi bu tür hastalarda iyileşme sürecinin hızlı olmasını sağlayacaktır.

Keywords

Ateşli silah yaralanması, Omurilik yaralanması, erken tedavi

References

• Bono CM, Heary RF: Gunshot wounds to the spine. Spine J. 2004; 4: 230-40.
• Isıklar ZU, Lindsey RW: Gunshot wounds to the spine. Injury 1998; 29: S-A7-S-A12.
• Jallo GI: Neurosurgical management of penetrating spinal injury. Surg Neurol. 1997; 47: 328-30.
• Kitchel SH: Current treatment of gunshot wounds to the spine. Clin Orthop Relat Res. 2003; 408: 115-19.
• Aryan HE, Amar AP, Ozgür BM, Levy ML: Gunshot wounds to the spine in adolescents. Neurosurgery 2005; 57: 748-52.
• Benzel EC, Hadden TA, Coleman JE: Civilian gunshot wounds to the spinal cord and cauda equina. Neurosurgery 1987; 20: 281-5.
• Özgen S: Penetran Omurilik Yaralanması
• Aarabi B, Alibaii E, Taghipur M, Kamgarpur A: Comparative study of functional recovery for surgically explored and conservatively managed spinal cord missile injuries. Neurosurgery 1996; 39: 1133-40.
• Simpson RK, Venger BH, Narayan RK: Treatment of acute penetrating injuries of the spine: A retrospective analysis. J Trauma 1989; 29: 42-6.
• Stauffer ES, Wood RW, Kelly EG: Gunshot wounds of the spine: The effects of laminectomy. J Bone Joint Surg. 1979, 61: 389-92.
• Waters RL, Adkins RH: The effects of removal of bullet fragment sretained in the spinal canal: A collaborative study by the National Spinal Cord Injury Model Systems. Spine 1991; 16: 934-9.
• Waters RL, Sie IH: Spinal cord injuries from gunshot wounds to the spine. Clin Orthop Relat Res. 408: 120-125, 200
• Heary RF, Vaccaro AR, Mesa JJ, Northrup BE, Albert TJ, Balderston RA, Cotler JM: Steroids and gunshot wounds to the spine. Neurosurgery 1997; 41: 576-84.
• Levy ML, Gans W, Wijesinghe H, SooHoo W, Adkins R, Stillerman CB: Use of methylprednisolone as an adjunct in the management of patients with penetrating spinal cord injury: Outcome analysis. Neurosurgery 1996; 39: 1141-9.