Abstract
Introduction
Retained shrapnel from gunshots is a common occurrence; however, retained shrapnel within the spinal canal is exceedingly uncommon. Guidelines for removal and treatment of these cases are a difficult topic, as surgical removal is not necessarily without consequence, and retention can lead to possible further injury or a secondary disease process of plumbism, which can be difficult to diagnose in this population.
Case presentation
This case report provides a unique example of a young patient with retained shrapnel from a gunshot. This patient suffered an initial spinal cord injury due to a gunshot and secondarily presented with abdominal pain, fatigue, elevated blood lead levels, and was diagnosed with plumbism. This was addressed with operative removal of shrapnel and posterior instrumented spinal fusion, resulting in decreased lead levels and symptom resolution postoperatively.
Discussion
Lead toxicity risk in patients with retained shrapnel, particularly in the spine, warrants vigilant monitoring. While management guidelines lack consensus, symptomatic lead toxicity may necessitate intervention. Residual neurological deficits complicate evaluation, emphasizing individualized management decisions.
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Data availability
The data generated or analyzed during this study was made up of several single data points recording this patient’s lead levels over time can be found within the published article and its supplementary files.
Change history
29 April 2024
The last word of the article title has been corrected.
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Authors and Affiliations
Contributions
Ezekial J Koslosky MD—Conceptualization, Investigation, Writing—Original Draft, Writing Review and Editing, Project Administration. Samuel Oshoba BA—Writing—Original Draft, Writing Review and Editing. Connor Armstrong MD—Investigation, Writing Review, and Editing. Christopher Chaput MD—Conceptualization, Supervision. Matthew Landrum MD—Conceptualization, Writing Review and Editing, Supervision.
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Ethical approval was not required for this case report as it involved the retrospective analysis of de-identified patient data and did not involve any interventions or procedures beyond routine clinical care. Furthermore, the study did not involve any identifiable information, and strict adherence to patient confidentiality was maintained throughout the data collection and reporting process. Thus, no formal ethical approval was sought or obtained for this case report.
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Koslosky, E., Oshoba, S., Armstrong, C. et al. Navigating the complexity of spinal cord injuries with retained foreign bodies and the diagnostic challenge of lead toxicity—a case report. Spinal Cord Ser Cases 10, 28 (2024). https://doi.org/10.1038/s41394-024-00640-7
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DOI: https://doi.org/10.1038/s41394-024-00640-7
