Heterotopic Bone Formation 20 Years After Gunshot Wound to the Cervical Spine: A Rare Cause of Progressive Cervical Myelopathy in a Previously Asymptomatic Patient

Rachel Womack, Evan Luther, Roberto J. Perez-Roman, Glen R. Manzano

Research output: Contribution to journalArticle

Abstract

Background: Gunshot wounds are the most common etiology of penetrating spine injuries and have been increasing in incidence in civilian populations. Although these injuries typically result in severe neurologic deficits, operative intervention remains is controversial and is usually reserved for patients with neurologic deterioration, a persistent externalized cerebrospinal fluid fistula, mechanical instability, metallic toxicity, or a bullet location at high risk of migration. Case Description: A previously asymptomatic patient who had sustained a gunshot wound to the cervical spine 20 years previously presented with new-onset progressive myelopathy and radiculopathy secondary to heterotopic ossification (HO) surrounding the retained bullet fragments near the left lateral masses of C5-T1. Computed tomography myelography demonstrated no cranial migration of contrast material past this region of the spine, suggesting severe spinal canal stenosis. Intraoperatively, bullet shrapnel and heterotopic bone fragments were found within the central canal causing compression of the spinal cord. Following decompression and stabilization, the patient had complete resolution of his symptoms and returned to his neurologic baseline. Although HO has been reported as a complication following through and through gunshot wounds, there is a paucity of literature discussing HO formation around retained bullet fragments in the spine. Conclusions: HO surrounding retained bullet fragments in the spine is a rare cause of progressive neurologic deterioration following gunshot wounds. Surgical excision of the shrapnel and heterotopic bone can lead to symptomatic relief, and therefore surgery should be considered as a treatment option in carefully selected patients.

Original languageEnglish (US)
Pages (from-to)197-201
Number of pages5
JournalWorld neurosurgery
Volume132
DOIs
StatePublished - Dec 2019

Fingerprint

Gunshot Wounds
Spinal Cord Diseases
Heterotopic Ossification
Osteogenesis
Spine
Nervous System
Bone and Bones
Spinal Stenosis
Myelography
Spinal Cord Compression
Radiculopathy
Spinal Canal
Wounds and Injuries
Neurologic Manifestations
Decompression
Contrast Media
Fistula
Cerebrospinal Fluid
Tomography
Incidence

Keywords

  • Cervical spine injury
  • Gunshot wound
  • Heterotopic ossification
  • Myelopathy
  • Radiculopathy
  • Retained bullet fragments

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Heterotopic Bone Formation 20 Years After Gunshot Wound to the Cervical Spine : A Rare Cause of Progressive Cervical Myelopathy in a Previously Asymptomatic Patient. / Womack, Rachel; Luther, Evan; Perez-Roman, Roberto J.; Manzano, Glen R.

In: World neurosurgery, Vol. 132, 12.2019, p. 197-201.

Research output: Contribution to journalArticle

@article{e1d8074ff09447bb8c5caf55bbf272e5,
title = "Heterotopic Bone Formation 20 Years After Gunshot Wound to the Cervical Spine: A Rare Cause of Progressive Cervical Myelopathy in a Previously Asymptomatic Patient",
abstract = "Background: Gunshot wounds are the most common etiology of penetrating spine injuries and have been increasing in incidence in civilian populations. Although these injuries typically result in severe neurologic deficits, operative intervention remains is controversial and is usually reserved for patients with neurologic deterioration, a persistent externalized cerebrospinal fluid fistula, mechanical instability, metallic toxicity, or a bullet location at high risk of migration. Case Description: A previously asymptomatic patient who had sustained a gunshot wound to the cervical spine 20 years previously presented with new-onset progressive myelopathy and radiculopathy secondary to heterotopic ossification (HO) surrounding the retained bullet fragments near the left lateral masses of C5-T1. Computed tomography myelography demonstrated no cranial migration of contrast material past this region of the spine, suggesting severe spinal canal stenosis. Intraoperatively, bullet shrapnel and heterotopic bone fragments were found within the central canal causing compression of the spinal cord. Following decompression and stabilization, the patient had complete resolution of his symptoms and returned to his neurologic baseline. Although HO has been reported as a complication following through and through gunshot wounds, there is a paucity of literature discussing HO formation around retained bullet fragments in the spine. Conclusions: HO surrounding retained bullet fragments in the spine is a rare cause of progressive neurologic deterioration following gunshot wounds. Surgical excision of the shrapnel and heterotopic bone can lead to symptomatic relief, and therefore surgery should be considered as a treatment option in carefully selected patients.",
keywords = "Cervical spine injury, Gunshot wound, Heterotopic ossification, Myelopathy, Radiculopathy, Retained bullet fragments",
author = "Rachel Womack and Evan Luther and Perez-Roman, {Roberto J.} and Manzano, {Glen R.}",
year = "2019",
month = "12",
doi = "10.1016/j.wneu.2019.08.093",
language = "English (US)",
volume = "132",
pages = "197--201",
journal = "World Neurosurgery",
issn = "1878-8750",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Heterotopic Bone Formation 20 Years After Gunshot Wound to the Cervical Spine

T2 - A Rare Cause of Progressive Cervical Myelopathy in a Previously Asymptomatic Patient

AU - Womack, Rachel

AU - Luther, Evan

AU - Perez-Roman, Roberto J.

AU - Manzano, Glen R.

PY - 2019/12

Y1 - 2019/12

N2 - Background: Gunshot wounds are the most common etiology of penetrating spine injuries and have been increasing in incidence in civilian populations. Although these injuries typically result in severe neurologic deficits, operative intervention remains is controversial and is usually reserved for patients with neurologic deterioration, a persistent externalized cerebrospinal fluid fistula, mechanical instability, metallic toxicity, or a bullet location at high risk of migration. Case Description: A previously asymptomatic patient who had sustained a gunshot wound to the cervical spine 20 years previously presented with new-onset progressive myelopathy and radiculopathy secondary to heterotopic ossification (HO) surrounding the retained bullet fragments near the left lateral masses of C5-T1. Computed tomography myelography demonstrated no cranial migration of contrast material past this region of the spine, suggesting severe spinal canal stenosis. Intraoperatively, bullet shrapnel and heterotopic bone fragments were found within the central canal causing compression of the spinal cord. Following decompression and stabilization, the patient had complete resolution of his symptoms and returned to his neurologic baseline. Although HO has been reported as a complication following through and through gunshot wounds, there is a paucity of literature discussing HO formation around retained bullet fragments in the spine. Conclusions: HO surrounding retained bullet fragments in the spine is a rare cause of progressive neurologic deterioration following gunshot wounds. Surgical excision of the shrapnel and heterotopic bone can lead to symptomatic relief, and therefore surgery should be considered as a treatment option in carefully selected patients.

AB - Background: Gunshot wounds are the most common etiology of penetrating spine injuries and have been increasing in incidence in civilian populations. Although these injuries typically result in severe neurologic deficits, operative intervention remains is controversial and is usually reserved for patients with neurologic deterioration, a persistent externalized cerebrospinal fluid fistula, mechanical instability, metallic toxicity, or a bullet location at high risk of migration. Case Description: A previously asymptomatic patient who had sustained a gunshot wound to the cervical spine 20 years previously presented with new-onset progressive myelopathy and radiculopathy secondary to heterotopic ossification (HO) surrounding the retained bullet fragments near the left lateral masses of C5-T1. Computed tomography myelography demonstrated no cranial migration of contrast material past this region of the spine, suggesting severe spinal canal stenosis. Intraoperatively, bullet shrapnel and heterotopic bone fragments were found within the central canal causing compression of the spinal cord. Following decompression and stabilization, the patient had complete resolution of his symptoms and returned to his neurologic baseline. Although HO has been reported as a complication following through and through gunshot wounds, there is a paucity of literature discussing HO formation around retained bullet fragments in the spine. Conclusions: HO surrounding retained bullet fragments in the spine is a rare cause of progressive neurologic deterioration following gunshot wounds. Surgical excision of the shrapnel and heterotopic bone can lead to symptomatic relief, and therefore surgery should be considered as a treatment option in carefully selected patients.

KW - Cervical spine injury

KW - Gunshot wound

KW - Heterotopic ossification

KW - Myelopathy

KW - Radiculopathy

KW - Retained bullet fragments

UR - http://www.scopus.com/inward/record.url?scp=85072696375&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85072696375&partnerID=8YFLogxK

U2 - 10.1016/j.wneu.2019.08.093

DO - 10.1016/j.wneu.2019.08.093

M3 - Article

C2 - 31450001

AN - SCOPUS:85072696375

VL - 132

SP - 197

EP - 201

JO - World Neurosurgery

JF - World Neurosurgery

SN - 1878-8750

ER -