Surgical treatment of the consequences of a gunshot wound to the lumbar spine using endoscopic techniques

Abstract

A clinical case of treatment of a patient with long-term consequences of a gunshot wound to the lumbar spine with a follow-up period of fifteen years is presented. In the last year and a half, the repeatedly recurrent retroperitoneal phlegmon associated with a foreign body of the lumbar spine has prompted a decision on the issue of surgical treatment (removal of a foreign body - a bullet). The location of the foreign body and previous experience with endoscopic foreign body removal played a decisive role in the choice of surgical tactics. Removal of the wounding projectile was performed using a percutaneous transforaminal endoscopic approach. The choice of such an approach was dictated by the peculiarity of the location of the foreign body (coaxial with the endoscopic tube in the foraminal approach), as well as sufficient experience in using the technique of percutaneous endoscopic surgery. At the same time, the conversion plan was worked out in sufficient detail with both posterolateral and anterior open approaches with the involvement of appropriate specialists. So, in case of failure, it was planned to transfer endoscopic access to “open,” using the already installed working tube of the endoscope as a conductor to a foreign body. In case of inefficiency, for some reason, this version of the operation was planned for the next, third stage: wound suturing, patient turning on the back with a right-hand retroperitoneal approach to the anterior-lateral surface of LI and LII bodies. Fortunately, the purpose of the operation was achieved using the most gentle version of the allowance. The given clinical case testifies that the technique of percutaneous transforaminal endoscopic surgery is not limited in indications to the treatment of degenerative-dystrophic diseases of the spine.

Keywords

non-penetrating gunshot bullet wound of the spine / lumbar spine / percutaneous transforaminal endoscopic surgery / endoscopic removal of foreign body / degenerative-dystrophic diseases of the spine

References

[1] Kravtsov MN, Landik SA, Dubinin AA, et al. Full-endoscopic surgery for gunshot penetrating wound of the lumbar spine (literature review and clinical case). Neyrokhirurgiya. 2018;20(2):66–73 (In Russ.). DOI: 10.17650/1683-3295-2018-20-2-66-73

[2] Кравцов М.Н. Ландик С.А., Дубинин А.А., и др. Чрескожная видеоэндоскопическая хирургия при огнестрельном проникающем ранении поясничного отдела позвоночника (обзор литературы и клиническое наблюдение) // Нейрохирургия. 2018. Т. 20, №. 2. С. 66–73. DOI: 10.17650/1683-3295-2018-20-2-66-73

[3] Henry E. Aryan, M.D, Arun P, et al. Gunshot Wounds to the Spine in Adolescents. Neurosurgery. 2005;57(4):748–752. DOI: 10.1227/01.NEU.0000175728.93653.b1

[4] Henry E. Aryan, M.D., Arun P., et al. Gunshot Wounds to the Spine in Adolescents // Neurosurgery. 2005. Vol. 57. No. 4. P. 748–752. DOI: 10.1227/01.NEU.0000175728.93653.b1

[5] Mogila VV, Maksimov SA. Features of gunshot wounds of the spine and spinal cord of the lumbosacral region. Tavrichesky medico-biologichesky vestnik. 2013;16(61):123–125. (In Russ.).

[6] Могила В.В., Максимов С.А. Особенности огнестрельных ранений позвоночника и спинного мозга пояснично-крестцового отдела // Таврический медико-биологический вестник. 2013. Т. 16, № 61. С. 123–125.

[7] Jakoi A, Iorio J, Howell R, et al. Gunshot Injuries of the Spine. Spine J. 2015;15 (9): 2077-2085. DOI: 10.1016/j.spinee.2015.06.007

[8] Jakoi A., Iorio J., Howell R., et al. Gunshot Injuries of the Spine // Spine J. 2015. Vol. 15. No. 9. P. 2077–2085. DOI: 10.1016/j.spinee.2015.06.007

[9] Bono CM, Heary RF. Gunshot wounds to the spine. The Spine Journal. 2004;4 (2): 230–240. DOI:10.1016/S1529-9430(03)00178-5

[10] Bono C.M., Heary R.F. Gunshot wounds to the spine // The Spine Journal. 2004. Vol. 4. No. 2. P. 230–240. DOI: 10.1016/S1529-9430(03)00178-5

[11] Jaiswal M, Mittal RS. Concept of gunshot wound spine. Asian Spine J. 2013;7(4): 359–364. DOI:10.4184/asj.2013.7/4/359

[12] Jaiswal M., Mittal R.S. Concept of gunshot wound spine // Asian Spine J 2013. Vol. 7. No. 4. P. 359–364. DOI: 10.4184/asj.2013.7/4/359

[13] Farmer JC, Vaccaro AR, Balderston RA. The changing nature of admissions to a spinal cord injury center: violence on the rise. Journal of spinal disorders. 1998;11(5):400–403. PMID: 9811100

[14] Farmer J.C., Vaccaro A.R., Balderston R.A. The changing nature of admissions to a spinal cord injury center: violence on the rise // Journal of spinal disorders. 1998. Vol. 11. No. 5. P. 400–403. PMID: 9811100

[15] Bumpass DB, Buchowski JM, Park A, et al. An update on civilian spinal gunshot wounds: treatment, neurological recovery, and complications. Spine. 2015;40(7):450–461. DOI: 10.1097/BRS

[16] Bumpass D.B., Buchowski J.M., Park A., et al. An update on civilian spinal gunshot wounds: treatment, neurological recovery, and complications // Spine 2015. Vol. 40. No. 7. P. 450–461. DOI: 10.1097/BRS

[17] Apte A, Bradford K, Dente C. Lead toxicity from retained bullet fragments: a systematic review and meta-analysis. Journal of Trauma and Acute Care Surgery. 2019;87(3): 707-716. DOI: 10.1097/TA.0000000000002287. PMID: 30939573

[18] Apte A., Bradford K., Dente C. Lead toxicity from retained bullet fragments: a systematic review and meta-analysis // Journal of Trauma and Acute Care Surgery. 2019. Vol. 87. No. 3. P. 707–716. DOI: 10.1097/TA.0000000000002287. PMID: 30939573

[19] Volkov PV, Sorokin KV. Long terms results of non-penetrative gunshot wound of lumbar spine with prevertebral abscess forming. Neyrokhirurgiya. 2011;(4):69–73 (In Russ.).

[20] Волков П.В., Сорокин К.В. Отдаленные последствия непроникающего огнестрельного ранения поясничного отдела позвоночника с формированием превертебрального абсцесса // Нейрохирургия. 2011. № 4. С. 69–73.

[21] Kosinskaya NS. X-ray diagnostics gunshot wounds of the spine and spinal cord. The experience of Soviet medicine in the Great Patriotic War 1941–1945. Ed. by E.I. Smirnov. Moscow: Medgiz. 1955;138–154.

[22] Косинская Н.С. Рентгенодиагностика огнестрельных ранений позвоночника и спинного мозга // Опыт советской медицины в Великой Отечественной войне 1941–1945 гг. / под ред. Е.И. Смирнова. М.: Медгиз, 1955. С. 138–154.

[23] Bulyshchenko GG, Gaivoronsky AI, Orlov VP, et al. Basic parameters of percutaneous endoscopic transforaminal approach using tessys. Rossiyskiy neyrochirurgicheskiy jurnal im. Professor Polenova. 2017;9 (1):14–19. (In Russ.).

[24] Булыщенко Г.Г., Гайворонский А.И., Орлов В.П., и др. Основные параметры чрескожного эндоскопического трансфораминального доступа с применением TESSYS // Российский нейрохирургический журнал им. профессора А.Л. Поленова. 2017. Т. 9, № 1. С. 14–19.

[25] Crutcher CL, Wilson JM, DiGiorgioet AM, et al. Minimally invasive management of civilian gunshot wounds to the lumbar spine: a case series and technical report. Operative neurosurgery. 2020;19(3):219–225. DOI: 10.1093/ons/opaa030

[26] Crutcher C.L., Wilson J.M., DiGiorgioet A.M., et al. Minimally invasive management of civilian gunshot wounds to the lumbar spine: a case series and technical report // Operative neurosurgery. 2020. Vol. 19. No. 3. P. 219–225. DOI: 10.1093/ons/opaa030

[27] Kravtsov MN, Landik SA, Dubinin AA, et al. Full-endoscopic surgery for gunshot penetrating wound of the lumbar spine (literature review and clinical case). Neyrokhirurgiya. 2018;20 (2):66–73 (In Russ.). DOI: 10.17650/1683-3295-2018-20-2-66-73.

[28] Кравцов М.Н. Ландик С.А., Дубинин А.А., и др. Чрескожная видеоэндоскопическая хирургия при огнестрельном проникающем ранении поясничного отдела позвоночника (обзор литературы и клиническое наблюдение) // Нейрохирургия. 2018. Т. 20, №. 2. С. 66–73. DOI: 10.17650/1683-3295-2018-20-2-66-73

[29] Henry E Aryan, MD, Arun P, et al. Gunshot Wounds to the Spine in Adolescents. Neurosurgery. 2005;57(4):748–752. DOI: 10.1227/01.NEU.0000175728.93653.b1

[30] Henry E. Aryan, M.D., Arun P., et al. Gunshot Wounds to the Spine in Adolescents // Neurosurgery 2005. Vol. 57. No. 4. P. 748–752. DOI: 10.1227/01.NEU.0000175728.93653.b1

[31] Mogila VV, Maksimov SA. Features of gunshot wounds of the spine and spinal cord of the lumbosacral region. Tavrichesky medico-biologichesky vestnik. 2013;16(61):123–125. (In Russ.).

[32] Могила В.В., Максимов С.А. Особенности огнестрельных ранений позвоночника и спинного мозга пояснично-крестцового отдела // Таврический медико-биологический вестник. 2013. Т. 16, № 61. С. 123–125.

[33] Jakoi A, Iorio J, Howell R, et al. Gunshot Injuries of the Spine. Spine J. 2015;15 (9): 2077-2085. DOI: 10.1016/j.spinee.2015.06.007

[34] Jakoi A., Iorio J., Howell R., et al. Gunshot Injuries of the Spine // Spine J. 2015. Vol. 15. No. 9. P. 2077–2085. DOI: 10.1016/j.spinee.2015.06.007

[35] Bono CM, Heary RF. Gunshot wounds to the spine. The Spine Journal. 2004;4 (2): 230–240. DOI:10.1016/S1529-9430(03)00178-5

[36] Bono C.M., Heary R.F. Gunshot wounds to the spine // The Spine Journal. 2004. Vol. 4. No. 2. P. 230–240. DOI:10.1016/S1529-9430(03)00178-5

[37] Jaiswal M, Mittal RS. Concept of gunshot wound spine. Asian Spine J. 2013;7(4): 359–364. DOI:10.4184/asj.2013.7/4/359

[38] Jaiswal M., Mittal R.S. Concept of gunshot wound spine. Asian Spine J 2013. Vol. 7. № 4. P. 359–364. DOI:10.4184/asj.2013.7/4/359

[39] Farmer JC, Vaccaro A.R, Balderston R.A. The changing nature of admissions to a spinal cord injury center: violence on the rise. Journal of Spinal Disorders. 1998;11(5):400–403. PMID: 9811100

[40] Farmer J.C., Vaccaro A.R., Balderston R.A. The changing nature of admissions to a spinal cord injury center: violence on the rise // Journal of spinal disorders. 1998. Vol. 11. № 5. P. 400–403. PMID: 9811100

[41] Bumpass DB, Buchowski JM, Park A, et al. An update on civilian spinal gunshot wounds: treatment, neurological recovery, and complications. Spine. 2015;40(7):450–461. DOI: 10.1097/BRS

[42] Bumpass D.B., Buchowski J.M., Park A., et al. An update on civilian spinal gunshot wounds: treatment, neurological recovery, and complications // Spine 2015. Vol. 40. № 7. P. 450–461. DOI: 10.1097/BRS

[43] Apte A, Bradford K, Dente C. Lead toxicity from retained bullet fragments: a systematic review and meta-analysis. Journal of Trauma and Acute Care Surgery. 2019;87(3): 707-716. DOI: 10.1097/TA.0000000000002287. PMID: 30939573

[44] Apte A., Bradford K., Dente C. Lead toxicity from retained bullet fragments: a systematic review and meta-analysis // Journal of Trauma and Acute Care Surgery. 2019. Vol. 87. № 3. P. 707-716. DOI: 10.1097/TA.0000000000002287. PMID: 30939573

[45] Volkov PV, Sorokin KV. Long terms results of non-penetrative gunshot wound of lumbar spine with prevertebral abscess forming. Neyrokhirurgiya. 2011;(4):69–73 (In Russ.).

[46] Волков П.В., Сорокин К.В. Отдаленные последствия непроникающего огнестрельного ранения поясничного отдела позвоночника с формированием превертебрального абсцесса // Нейрохирургия. 2011. № 4. С. 69–73.

[47] Kosinskaya NS X-ray diagnostics gunshot wounds of the spine and spinal cord. The experience of Soviet medicine in the Great Patriotic War 1941–1945. Ed. by E.I. Smirnov. Moscow: Medgiz. 1955;138–154.

[48] Косинская Н.С. Рентгенодиагностика огнестрельных ранений позвоночника и спинного мозга // Опыт советской медицины в Великой Отечественной войне 1941–1945 гг. / под ред. Е.И. Смирнова. М.: Медгиз, 1955. С. 138–154.

[49] Bulyshchenko GG, Gaivoronsky AI, Orlov VP, et al. Basic parameters of percutaneous endoscopic transforaminal approach using tessys. Rossiyskiy neyrochirurgicheskiy jurnal im. Professor Polenova. 2017;9 (1):14–19. (In Russ.).

[50] Булыщенко Г. Г., Гайворонский А.И., Орлов В.П., и др. Основные параметры чрескожного эндоскопического трансфораминального доступа с применением TESSYS // Российский нейрохирургический журнал им. профессора А.Л. Поленова. 2017. Т. 9, №. 1. С. 14–19.

[51] Crutcher CL, Wilson JM, DiGiorgioet AM, et al. Minimally invasive management of civilian gunshot wounds to the lumbar spine: a case series and technical report. Operative neurosurgery. 2020;19(3):219–225. DOI: 10.1093/ons/opaa030

[52] Crutcher C.L., Wilson J.M., DiGiorgioet A.M., et al. Minimally invasive management of civilian gunshot wounds to the lumbar spine: a case series and technical report // Operative neurosurgery. 2020. Vol. 19. № 3. P. 219–225. DOI: 10.1093/ons/opaa030

RIGHTS & PERMISSIONS

Bulyschenko G.G., Gayvoronsky A.I., Liev P.S., Kuznetsov M.V., Svistov D.V.