View/Download PDF

Translate this page into:
Notice: Please configure GTranslate from WP-Admin -> Settings -> GTranslate to see it in action.

Video Abstract

Surgical removal of a spinal intrathecal projectile led to a significant improvement of cauda equina syndrome

Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States.
Corresponding author: Zaid Aljuboori, Department of Neurosurgery, University of Louisville, 220 Abraham Flexner Way Ste. 1500, Louisville, Kentucky 40202, United States.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Aljuboori Z. Surgical removal of a spinal intrathecal projectile led to a significant improvement of cauda equina syndrome. Surg Neurol Int 2020;11:227.



Penetrating gunshot wounds of the spine are common and can cause severe neurological deficits. However, there are no guidelines as to their optimal treatment. Here, we present a penetrating injury to the lower thoracic spine at the T12 level that lodged within the canal at L1, resulting in a cauda equina syndrome. Notably, the patient’s deficit resolved following bullet removal.

Case Description:

A 29-year-old male sustained a gunshot injury. The bullet entered the right lower chest, went through the liver, entered the spinal canal at T12, fractured the right T12/L1 facet, and settled within the canal at the L1 level. The patient presented with severe burning pain in the right leg, and perineum. On exam, he had right-sided moderate weakness of the iliopsoas and quadriceps femoris muscles, a right-sided foot drop, decreased sensation throughout the right leg, and urinary retention. Computed tomography myelography showed the bullet located intrathecally at the L1 level causing compression of the cauda equina. The patient underwent an L1 laminectomy with durotomy for bullet removal. Immediately postoperatively, the patient improved; motor power returned to normal, the sensory exam significantly improved; and he was left with only mild residual numbness and burning pain in the right leg.


With gunshot injuries, there is a direct correlation between the location/severity of the neurological injury and the potential for recovery. In patients with incomplete cauda equina syndromes, bullet extraction may prove beneficial to neurological outcomes.


Cauda equina


  1. 2:55 – Exposure.

  2. 3:00 – Laminectomy.

  3. 3:22 – Durotomy.

  4. 3:50 – Bullet removal.

Declaration of patient consent

Patient’s consent not required as patients identity is not disclosed or compromised.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

[Video 1]-Available on:


  1. , , , , , , . Penetrating spinal column injuries (pSI): An institutional experience with 100 consecutive cases in an urban trauma center. World Neurosurg. 2020;138:e551-6.
    [Google Scholar]
  2. , , . Gunshot wound causing complete spinal cord injury without mechanical violation of spinal axis: Case report with review of literature. J Craniovertebr Junction Spine. 2015;6:149-57.
    [Google Scholar]
  3. , , . High velocity gunshot injuries to the extremities: Management on and off the battlefield. Curr Rev Musculoskelet Med. 2015;8:312-7.
    [Google Scholar]

Fulltext Views

PDF downloads
View/Download PDF
Download Citations
Show Sections