European Spine Journal

, Volume 27, Issue 8, pp 1688–1689 | Cite as

Expert’s comment concerning Grand Rounds case entitled “Management of a posterior gunshot injury with a floating pedicle and cerebrospinal fluid leak” by A. Bourghli, S. Abouhashem, R. Abo Wali, I. Obeid, L. Boissiere, J. M. Vital, M. Al Sarawan (Eur Spine J; 2018. DOI 10.1007/s00586-018-5537-9)

Reviewer's Comment

Open image in new window When Lord Nelson sustained a spinal cord injury from a gunshot at the Battle of Trafalgar his personal surgeon told him, ‘My Lord, unhappily for our country, nothing can be done for you’. Nelson died a few hours later [1]. Since then, spine gunshot wounds have become far more common, not only in war, but in representing around 15% of spinal injuries in the civilian population [2]. This incidence is widely varied dependent on local laws governing gun access and degree to which the police force is armed. Most civilian injuries are low velocity from handguns for this reason.

The authors present an interesting case with a retained bullet having traversed the distal lumbar spinal canal, fracturing the right base of pedicle and pars, transecting the right L5 root and coming to rest in the L5/S1 foramen with another fragment more distal.

There are many controversies around the management of musculoskeletal gunshots and more so spinal as regards the need to debride,...


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Conflict of interest

The author declares that he has no conflict of interest.


  1. 1.
    DeVivo MJ, Stover SL, Black KJ (1992) Prognostic factors for 12-year survival after spinal cord injury. Arch Phys Med Rehabil 73:156–162PubMedGoogle Scholar
  2. 2.
    Sothmann J, Stander J, Kruger N, Dunn R (2015) Epidemiology of acute spinal cord injuries in the Groote Schuur Hospital Acute Spinal Cord Injury (GSH ASCI) Unit, Cape Town, South Africa, over the past 11 years. S Afr Med J 105(10):835–839. CrossRefPubMedGoogle Scholar
  3. 3.
    Le Roux JC, Dunn RN (2005) Gunshot injuries of the spine—a review of 49 cases managed at the Groote Schuur Acute Spinal Cord Injury Unit. S Afr J Surg 43:165–168PubMedGoogle Scholar
  4. 4.
    Botha AH, Booysen BC, Dunn RN (2016) Civilian gunshot wounds of the spine: a literature review. S Afr Orthop J 15(3):13–19Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryGroote Schuur Hospital, University of Cape TownCape TownSouth Africa

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