There are few reported instances of intraspinal migration of a bullet fragment. The majority of these migrations occur caudally, typically below the level of T10. Even fewer cases demonstrate cephalad migration from the sacral spine to the lumbar spine.
Todnem et al., from the Department of Neurosurgery, Medical College of Georgia at Augusta University, reported for the first time a case of a cephalad migration intradurally from the thoracic spine to cervical spine.
A 31-year old man presented to the Emergency Department (ED) with a suspected spinal cord injury following a gunshot wound (GSW) sustained to the left shoulder. A penetrating gunshot injury to the thoracic spine at the level of T2 was observed, and CT angiography revealed a cephalad migration of the bullet fragment to the level of C6. The patient had marked weakness of the bilateral upper extremities, with paraplegia of the lower extremities. There was a sensory deficit beginning at a level 1 cm below the clavicle, as well as a decrease in rectal tone.
They performed a laminectomy at C6 with dural incision and removal of the main bullet fragment. Following the surgery, significant improvement in strength and sensation in the bilateral upper extremities was noted, but paraplegia and sensory loss below the level of T2 persisted.
In this report, they review the previously reported cases in which intraspinal migration of bullets have occurred, and discuss the unique finding in this study of cephald migration of a bullet within the dura. Additionally, they detail considerations in the management of such injuries 1).
Vasudevan RR, Galvan G, Pait GT, Villavicencio AT, Bulsara KR. Muscle splitting approach with MetrX system for removal of intrathecal bullet fragment: a case report. J Trauma. 2007 May;62(5):1290-1. PubMed PMID: 17495741.