PMC9990798_01
Sagittal view of thoracic spine preoperative computed tomography. Red arrow indicates bullet location.
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F1
A 25-year-old male sustained a GSW to the T6 spine (4/2017); the bullet entered his right shoulder, passed through his lung, and ended up in the T6 vertebrae resulting in paraplegia [Figure 1].
Sagittal view of thoracic spine postoperative computed tomography. Red arrow indicates preoperative bullet location.
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F2
T5-T7 laminectomy for removal of the retained bullet fragment accompanied by the left-sided facetectomies at T5-T6 and T6-T7, and performance of a T4-T8 pedicle/screw fusion. The bullet, lodged extradurally, was removed along with 40% of the T6 vertebral body [Figure 2].
Intraoperative X-ray following epidural spinal cord stimulation placement. Red arrow indicates electrode grid.
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F3
One month later, an eSCS was placed dorsal to the L1-2 vertebral bodies using intraoperative neuromonitoring (i.e., for stimulation of all muscle groups from the iliopsoas to the anterior tibialis, including the anal sphincter) [Figure 3].