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CHAPTER 13
(4)
Missile lodged extradurally
Marburg and Ranzi found this type in 9 cases of cauda equina level and in 20 cases at
various levels of the cord amongst a total of 145 operated patients. This injury may occur
if the missile has been fired from a great distance and lost a good deal of its power by
penetrating other parts of the body.
(5)
Ricochet-injury of the spinal cord
This type of injury occurs if the projectile hits the vertebral body, spinous or articular
processes producing a fracture and injury to the cord or its roots. However, by the impact
of the missile on the bone, it is deviated from its original course and ricochets towards
the site of its entry into the body. A most unusual case in this respect was described by
Foerster (1929). A bullet went through the teeth and mouth to the anterior surface of
the cervical spine of a soldier and ricocheted from there to the mouth, was swallowed
by the patient who later passed it per vias naturales. As a result of the impact of the
bullet on the cervical spine the soldier sustained a tetraplegia.
(6)
Indirect cord damage following gunshot injuries to other parts of the body
Such cord damage was observed following gunshot injuries to nerve trunks, in particular
the arm plexus (Leva, 1915). Reinhardt (1915) described a case where the bullet avulsed
a spinal nerve resulting in a tear of the dura and producing a traction lesion of the spinal
cord involving the posterior and lateral tracts. Foerster (1929) published an interesting
X-ray of a case where the bullet penetrated the thorax anteriorly and struck the nth rib,
bending the nose of the bullet which lodged on the inside of the rib about 8 cm from the
spine. There was an immediate complete transverse lesion of the cord following the impact
of the bullet on the rib resulting in violent tearing and traction of the rib at its articulation
with the corresponding vertebra.
BLAST INJURY OF THE SPINAL CORD
In both World Wars cases of spinal cord injury following exposure to the effects of a
detonating high explosives such as mine or grenade were described. Only those cases
are considered who were not thrown to the ground. In the First World War Mott (1916)
studied the anatomical changes of the brain and spinal cord in two cases who died a short
time after a grenade explosion. He found extreme venous stasis in the small vessels of
the brain and spinal cord with rupture of their wall and small perivascular haemorrhages;
and Marinesco (1918) and Mairet & Durante (1919) found in their experiments in dogs
and rabbits in addition to many major and small haemorrhages in internal organs,
especially lungs, numerous echymoses and perivascular haemorrhages in brain and
spinal cord with enormous dilatation of the lymph sheaths of the vessels. Marinesco
found the haemorrhages more marked in the grey matter than in the white tracts of the
spinal cord, and in agreement with Mott he also found pathological changes of the gang
lion cells in the acute cases. In the Second World War Zuckerman (1940) described
