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Abstract
RESUME
les traumatismes vertébro-médullaires d’origine balistiques sont des lésions graves, entrainant généralement un déficit neurologique total. La chirurgie décompressive reste à ce jour le seul gage de neuroprotection et de récupération neurologique à long terme. Les traumatismes vertébro-médullaires par arme à feu sont exceptionnels dans notre contexte. Les lésions aboutissent à l’œdème et à l’ischémie médullaire. Nous rapportons le cas d’un patient de 30 ans, admis en urgence pour un déficit moteur complet des 4 membres secondaires à une plaie balistique de la région cervicale. Le diagnostic de traumatisme vertébro---médullaire Frankel A a été posé, avec à la TDM du rachis cervical une fracture transversale déplacée de la lame de C2 à gauche, une fracture de la lame de C3 et de C4 à droite rétrécissant le canal médullaire en regard, et une balle intra-canalaire en regard de la vertèbre C3. Le patient a bénéficié d’une laminectomie décompressive C3C4C5, et l’évolution post opératoire a été marquée par une récupération sensitivo-motrice complète.
ABSTRACT
Ballistic vertebro-medullary trauma is a serious injury, generally resulting in total neurological deficit. To date, decompressive surgery remains the only guarantee of neuroprotection and long-term neurological recovery. Vertebro-medullary trauma caused by firearms is exceptional in our context. Injuries lead to oedema and spinal cord ischaemia. We report the case of a 30-year-old patient admitted in emergency with complete motor deficit in all 4 limbs secondary to a ballistic wound in the cervical region. The diagnosis of Frankel A spinal injury was made, with a displaced transverse fracture of the lamina of C2 on the left, a fracture of the lamina of C3 and C4 on the right narrowing the medullary canal opposite, and an intra-canal bullet opposite the C3 vertebra. The patient underwent a C3C4C5 decompressive laminectomy, and the postoperative course was marked by complete sensory-motor recovery.
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References
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- [5] Jean Bahebeck, Rene Atangana, Emile Mboudou, Bernadette Ngo Nonga, Maurice Sosso, Eimo Malonga. Incidence, case-fatality rate and clinical pattern of firearm injuries in two cities
- where arm owning is forbidden. Injury, Int. J. Care Injured (2005) 36, 714—717.
- [6] Laurence Ge, MD, Ayodeji Jubril, MD, MS, and Addisu Mesfin, MD. Civilian Gun Shot Wounds Associated With Spinal Injuries. Global Spine Journal 2022, Vol. 12(7) 1428–1433.
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References
[1] Bello F, Oumarou HN, Nchufor RN, Lekane Tsafack A, Mbele Messanga GI, Dongmo Tchemeza AA, Mve Ela AG, Djientcheu VDP. Aspects Diagnostiques, Thérapeutiques et Pronostiques des Traumatismes du Rachis à Yaoundé. Health Sci. Dis: Vol 21 (12) December 2020 pp 59-62
[2] Bumbasirevic M, Lesic A, Bumbasirevic V, Rakocevic Z, Djuric M. Gunshot injury to the face with a missile lodged in the upper cervical spine without neurological deficit. Dentomaxillofac Radiol 2006;35(January (1)):38–42.
[3] Tender GC, Ratliff J, Awasthi D, Buechter K. Gunshot wounds to the neck. South Med J 2001;94:830–2.
[4] Brohi SR, Brohi AR, Brohi QR. Brown–Sequard syndrome following firearm injury with a bullet lodged in the upper cervical canal. J Coll Physicians Surg Pak 2008;8(May (5)):312–3.
[5] Jean Bahebeck, Rene Atangana, Emile Mboudou, Bernadette Ngo Nonga, Maurice Sosso, Eimo Malonga. Incidence, case-fatality rate and clinical pattern of firearm injuries in two cities
where arm owning is forbidden. Injury, Int. J. Care Injured (2005) 36, 714—717.
[6] Laurence Ge, MD, Ayodeji Jubril, MD, MS, and Addisu Mesfin, MD. Civilian Gun Shot Wounds Associated With Spinal Injuries. Global Spine Journal 2022, Vol. 12(7) 1428–1433.
[7] Abbas A, Aziz HF, Rizvi R, Rehaman L, Javeed F, Afzal A. Gunshot acquired spinal cord injury in civilians. Turk Neurosurg. 2019;29(4):506-512. doi:10.5137/1019-5149.JTN.24121-18.2.
[8] Venger BH, Simpson RK, Narayan RK. Neurosurgical intervention in penetrating spinal trauma with associated visceral injury. J Neurosurg. 1989;70(4):514-518