Gunshot wounds to the spine account for 13% to 17% of all gunshot injuries and occur predominantly in the thoracic region. Minimally invasive spine surgery procedures implementing serial muscle dilation and the use of a tubular retracting system with a working channel minimize soft tissue trauma, facilitate less bony and soft tissue resection, decrease blood loss, minimize scarring and improve cosmesis, decrease hospitalization, and reduce postoperative pain and narcotic usage in comparison to more open, traditional approaches. Although minimally invasive spine surgery techniques and instrumentation have gained considerable attention, their application in the management of gunshot injuries to the sacrum has not been reported. The following is a brief case report of a 21-year-old male who sustained a gunshot injury to the sacrum who was managed operatively via minimally invasive spine surgery techniques and instrumentation.
Cicatrix ; Hospitalization ; Humans ; Male ; Muscles ; Pain, Postoperative ; Sacrum ; Spine ; Wounds, Gunshot

Adolescent ; Cervical Vertebrae ; physiopathology ; Female ; Humans ; Klippel-Feil Syndrome ; diagnosis ; diagnostic imaging ; physiopathology ; Neck Pain ; physiopathology ; Radiography ; Range of Motion, Articular ; Scoliosis ; congenital ; diagnosis ; diagnostic imaging ; physiopathology

Abnormalities, Multiple ; diagnostic imaging ; Female ; Humans ; Infant ; Lumbar Vertebrae ; abnormalities ; Neural Tube Defects ; diagnostic imaging ; Radiography ; Sacrum ; abnormalities ; Scoliosis ; diagnostic imaging

Methods: This was a retrospective study on normal lumbar spine lateral radiographs of patients who presented with low back pain and were reviewed by two observers. Different inclination angles were constructed to estimate the safety zones of the pedicle screws’ sagittal inclination. Results: Radiographs of 30 consecutive patients, 25 females and five males, with a mean age of 39.43±11.18 years, were studied. The mean angle of the interlaminar line and the pedicle axis was almost orthogonal at all the levels, with a range of 89.16°–94.63°, which was not affected by the lumbar sagittal profile. The safety zones of the pedicle screws were measured, and they revealed a safe sagittal range of 19.73°–24.40° if the screw was inserted from the pedicle axis, 21.03°–22.59° if inserted from the most cephalic part, and 13.31°–17.03° if inserted from the most caudal part. Conclusions Our results confirmed the perpendicularity of the interlaminar line with the pedicle axis in the lumbar spine at all the levels. The interlaminar line is a useful guide for pedicle screw sagittal inclination.

Methods: This was a retrospective study on the computed tomography (CT) chest scans of patients with no spinal pathologies. The ILL–PA, superior and inferior safe angles of the pedicle screw trajectories, and the exit zone of the screw perpendicular to the ILL were reviewed by two observers via three-dimensional multiplanar reconstruction mode of the Horos DICOM software (https:// horosproject.org/). Results: The CT chest images of 30 consecutive patients (20 males and 10 females) with a mean age of 49.87±15.48 years (range, 24–74 years) were evaluated. The mean ILL–PA angle was almost orthogonal for all levels. This angle ranged between 86.21°±3.01° at D5 and 90.59°±2.72° at D10. The safety zones of the sagittal inclination of the pedicle screws were demonstrated. The results revealed that the least safe angle was when the screw was directed cranially along the middle part of the pedicle between 4.43°±0.75° at D8 and 6.94°±1.19° at D11. Conclusions The results of this study confirmed the ILL–PA angle perpendicularity in the thoracic spine at all levels. The ILL is a useful guide for pedicle screw sagittal inclination.

Methods: This was a retrospective study on the computed tomography (CT) chest scans of patients with no spinal pathologies. The ILL–PA, superior and inferior safe angles of the pedicle screw trajectories, and the exit zone of the screw perpendicular to the ILL were reviewed by two observers via three-dimensional multiplanar reconstruction mode of the Horos DICOM software (https:// horosproject.org/). Results: The CT chest images of 30 consecutive patients (20 males and 10 females) with a mean age of 49.87±15.48 years (range, 24–74 years) were evaluated. The mean ILL–PA angle was almost orthogonal for all levels. This angle ranged between 86.21°±3.01° at D5 and 90.59°±2.72° at D10. The safety zones of the sagittal inclination of the pedicle screws were demonstrated. The results revealed that the least safe angle was when the screw was directed cranially along the middle part of the pedicle between 4.43°±0.75° at D8 and 6.94°±1.19° at D11. Conclusions The results of this study confirmed the ILL–PA angle perpendicularity in the thoracic spine at all levels. The ILL is a useful guide for pedicle screw sagittal inclination.