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  4. Central cord syndrome from blast injury after gunshot wound to the spine: a case report and a review of the literature

Central cord syndrome from blast injury after gunshot wound to the spine: a case report and a review of the literature

Spinal Cord Series and Cases, 2017 · DOI: 10.1038/scsandc.2017.3 · Published: March 16, 2017

Spinal Cord InjuryTrauma

Simple Explanation

Central Cord Syndrome (CCS) is the most common of the spinal cord injury syndromes. Few cases have been presented with gunshot wound (GSW) as a cause of a central cord syndrome, and none, to our knowledge, has been presented without any evidence of central canal bullet/bone fragments. A 27-year-old male suffered two close-range gunshot wounds, one to the left neck and one to the left shoulder. CT scan showed C5 spinous process fracture and paraspinal muscle hemorrhage without evidence of central canal stenosis or bullet/bone fragments. Four months post injury, the patient had almost full recovery with only left proximal arm and bilateral distal hand weakness.

Study Duration
Not specified
Participants
A 27-year-old male
Evidence Level
Level 4; Case Report and Literature Review

Key Findings

  • 1
    Only four cases of CCS caused by GSW have been reported in the literature. In all of the above-mentioned cases, there was radiological or surgical evidence of spinal canal bullet or bone fragments.
  • 2
    GSW to the spine can cause direct or indirect injuries. Direct injuries result from the bullet nucleus, broken metallic or bone particles and disc material. Indirect injuries result from the hydrodynamic strike effect (blast wave or cavitation wave) that cause damage distant to the projectile trajectory.
  • 3
    At 1-year follow-up, the patient showed full independence with minor deficits consistent with the proposed prognosis of most CCS.

Research Summary

Central Cord Syndrome (CCS) is the most common of the spinal cord injury syndromes. Few cases have been presented with gunshot wound (GSW) as a cause of a central cord syndrome, and none, to our knowledge, has been presented without any evidence of central canal bullet/bone fragments. A 27-year-old male suffered two close-range gunshot wounds, one to the left neck and one to the left shoulder. CT scan showed C5 spinous process fracture and paraspinal muscle hemorrhage without evidence of central canal stenosis or bullet/bone fragments. At 1-year follow-up, the patient showed full independence with minor deficits consistent with the proposed prognosis of most CCS.

Practical Implications

Individualized Management

Cases should be individualized depending on the specific nature of their presentation.

Conservative Management

Diagnosis of CCS with a stable, nonprogressive injury can be managed conservatively with aggressive rehab.

Surgical intervention

Spinal instability is an absolute indication for surgery, regardless of the severity of injury

Study Limitations

  • 1
    MRI study could not be performed due to the presence of a bullet slug on the left arm.
  • 2
    Small number of similar cases reported in the literature
  • 3
    Lack of definitive imaging criteria for the diagnosis of CCS

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