Neurogenic claudication and radiculopathy as delayed presentations of retained spinal bullet

Background context: Firearm injuries to the spine may cause injury to the neurological structures and/or to the spine, including ligaments and bones. Purpose: Patients usually present with symptoms immediately after injury. However, only a few cases have been reported where a patient is neurologically intact after the initial injury but develops deficits several months or years later. Almost all these cases develop delayed neurological deficit because of bullet migration. Study design: Case report. Methods: A discussion, with a relevant review of the literature, the clinical histories, and radiological findings of two patients who experienced delayed neurological symptoms after gunshot wounds to the spine. Results: One patient presented after 14 years and the other after 5 months from the day of injury. Both cases are unique in that the delayed symptoms appeared because of formation of a reactive mass around the site of bullet impact. Lack of serial imaging studies is a barrier to the exclusion of bullet migration as an alternate cause of delayed symptoms. Conclusion: These cases illustrate that retained intraspinal bullets can present with delayed neurological findings secondary to reactive changes around the bullet.