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Q&A: How Would a Gunshot Wound to the Spine Be Treated and Rehabilitated?

13 Aug

Q: In my novel, the main character is a homicide detective who is shot in the back. The bullet lodges between her T11 and T12 vertebrae, cutting into her spinal cord and leaving her paralyzed from the waist down. What would be a reason for the doctors to remove the bullet immediately and how long would she be in the hospital before rehabilitation was started? Also, what type of rehabilitation would she face, how long would it be before she could return home and what type of job opportunities would the police department offer her?

DCooper, Sewell NJ

A: Surgery would be done to control any bleeding and to attempt to salvage as much spinal function as possible. With this type of injury there would be direct damage to the spinal cord by the bullet and indirect damage from the fractured vertebrae in the area and from pressure as blood accumulated in what we call a hematoma. This is simply a mass of blood and it can apply pressure to the cord and make things initially look worse than they are. The surgeon would remove the bullet—if possible. He might or might not since removing it could cause more injury than leaving it in place. Usually though it is removed. He would remove any hematoma that had collected, control any bleeding, and repair the damaged vertebrae if possible. The surgery would probably be done by a neurosurgeon and an orthopedic surgeon, working together.

Recovery is extremely variable and depends upon the exact nature of the injury, the effectiveness of the surgery, the person it happens to, and luck. So you can have it go almost anyway you want. Full recovery is possible, full paraplegia (paralysis below the waist) is possible, and anywhere in between. Rehab is usually begun in the hospital a few days after surgery and continued after discharge. She might be in an ICU for 3 or 4 days, a regular hospital surgical bed for a week (here is where rehab would begin with simple range of motion exercises as possible and passive movement of the limbs, etc), and then she would be transferred to an in-hospital rehab unit for a few weeks. This is all very general and depends upon what’s happening with the victim and the level of sophistication of the hospital.

If she indeed suffered permanent paralysis, she could perform any type of desk job such as dispatcher, records custodian, that kind of thing. She could also begin a new career in the crime lab. Many crime lab techs are previous police officers who then train on the job in such things as fingerprints, firearms, etc.

 
11 Comments

Posted by on August 13, 2010 in Medical Issues, Q&A, Trauma

 

11 responses to “Q&A: How Would a Gunshot Wound to the Spine Be Treated and Rehabilitated?

  1. Laura Mitchell

    August 14, 2010 at 4:26 pm

    1) Doesn’t the degree of functioning depend also on whether this is a complete or partial transection? And couldn’t our patient have some partial sensory, as well as motor function?
    2) It’s been a long time since I did neuro, but wouldn’t this kind of paralysis be “paraplegia,” rather than “hemiparesis?” The patients I’ve taken care of with hemiparesis have been stroke patients, with one side affected.

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    • D.P. Lyle, MD

      August 15, 2010 at 8:18 am

      Thanks for picking up on my error. I meant paraplegia and not hemiparesis. That’s what I get for blogging late at night. The degree of dysfunction depends upon the amount of damage, whether the cord is contused or lacerated. The defect is related to then number and the types of neuronal axons damaged by the injury. These injuries come in so many flavors that the entire scope of these types of injuries would take a chapter in a neuro textbook to cover. It’s a recurrent problem in trying answer questions for writers—how much is enough? How much is too much? Thanks for you input.

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  2. M Haynes

    August 31, 2010 at 8:23 pm

    I have a SCI due to a gunshot wound at the T-11/T-12 vertebrae when I was 20 years old. They did an exploratory operation immediately in the front to see if there were any vital organs injured and then two days later opened up my back at the wound site to clear out any bone & bullet fragments that were loose. I still have most of the bullet embedded in bone and often set off metal detectors when scanned. I also can’t have MRIs because of the metal in my back. I also have a complete transection of my cord and so have no movement or sensation below my level of injury making me an ASIA A scoring.

    Rehab would start as soon as the patient is stable enough to be released from the acute care hospital. I was transferred out of the acute care facility within two weeks of my injury and started rehab immediately. It would depend on the disability what rehab they would receive, but for sure they would get Physical and Occupational Rehab. The time spent in rehab would depend on her progress and health. I was ready to be released in three weeks of rehab, but then got spinal menengitis and had to return back to the acute care hospital. I spent 11 months and two weeks in the hospital because of medical setbacks caused by the gunshot wound. I ended up having brain surgery because I had an abcess of white blood cells trapped in my corpus callosum.

    The police dept would probably offer her a desk job or a detective job if she were to return to work. It would be very difficult for a person with SCI to be a regular police officer like the cartoon on Family Guy.

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    • D.P. Lyle, MD

      August 31, 2010 at 8:36 pm

      Thank you for sharing your story and insights with us. That’s both helpful and generous.

      DP Lyle

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  3. dea

    December 16, 2011 at 5:10 pm

    i have a bullet lodge in my t3,t4 cavity my spinal cord is intact unremarkable is what the surgeon said but did not remove the bullet. what would be the odds of having the bullet removed 9 months later. I am able to move my toes faintly as well as my knees. i am willing to travel if there is some hope of having the bullet removed to have this pressure lifted off of me please anyone any suggestions.

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  4. bryan chavez

    June 24, 2013 at 12:19 am

    I got shot wen i was 18 yrs old and they decided not to remove it thank god im still walking the bullet was 2inches nearr the spine i go through pain daily too and i want it to get removed

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    • Jax Cortez

      September 5, 2015 at 8:38 am

      Bryan Chavez, can you tell me what part of the spine that was? I’m doing research for a book I’m working on and one of my characters got shot in the back, but is still mobile. Anymore information you can add to this topic is appreciated, thanks!
      Jax Cortez

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  5. Jax Cortez

    September 5, 2015 at 8:42 am

    Thank you for the information. I came across your blog from a Google search and it helped to know which part of the spine would render one immobile.

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    • Lucy

      December 21, 2015 at 6:36 am

      My brother just had a gun shot injury to his spine, and really don’t know what part of the spine it affected. Which part if affected usually cause paralysis? Is been one week to since he had the injury, and he said he can feel his legs a little bit.

      How long of recovery is he looking at right now? Unfortunately, he’s in Africa and the medical teams over there really need help. So please, what should we expect at this point, based on his healing. He has been lying down for one week now, and had not had any bowel sound/ movement. Is that a big problem?
      Thanks!
      Lulu.

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      • D.P. Lyle, MD

        December 21, 2015 at 8:16 am

        Lulu–I’m sorry to hear this but since I don’t know the exact nature of his injury–and more importantly am not involved in his care–it would not be appropriate to make any comments about treatment or prognosis. I suggest you talk with the physicians who are treating him.

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      • lucy

        December 21, 2015 at 8:36 am

        Oh ok….I do understand,but he’s in Nigeria and our health care system over there is nothing to talk about. I just wanted to get an idea of how much damage that injury could caused him. He’s only 26 years, and just graduated from college. Well I really do appreciate you writing back to me.
        Thanks a lot!

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