To the Editor.—
Although it is generally believed, as stated by Nino et al (240:1173, 1978), that "foreign objects should always be removed from the spinal canal," demonstration that removal of bone or lead fragments is actually of benefit remains unproved. Many patients, especially those with partial cord function, will show improvement without surgery. While I agree with Nino and associates, that late deterioration of cord function may be associated with syringomyelia or fibrous scarring, I know of no evidence that early surgery will prevent such worsening. Also, one should keep in mind the possibility that the presence of copper (a jacketing on many bullets) can lead to progressive cyst formation and deterioration in the CNS.1Many of us with much experience in the management of gunshot wounds of the spine have certainly seen patients made worse or even die after laminectomy. Therefore, I would urge conservatism and disagree
Messer HD. Foreign Objects in the Spinal Canal. JAMA. 1979;241(25):2701. doi:10.1001/jama.1979.03290510015009
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