**4. Summary**

The presence of foreign body inside the spinal canal was not shown to be associated with increased risk of infection, regardless of the previous path of the bullet, prior to its final location in the spinal canal [92, 93]. Thus, we do not consider bullet removal as an indication for

is shown outside of the patient's spine; (e) C1 ring following osteosynthesis.

80 Essentials of Spinal Cord Injury Medicine

**Figure 2.** A 30-year-old patient, who sustained a low-velocity gunshot wound. He had a few entry wounds in his head and neck. He was conscious, alert, and hemodynamically stable with normal neurological status. The following images describe the evolution of events. (a) Plain radiograph showing the patient's skull with a bullet located at the center; (b) axial CT scan showing the broken arc of C1 with the bullet located next to the dens; (c) trans-oral approach to C1 vertebra with the bullet at the base of the surgical dissection. The smiley gives the orientation of the patient's face; (d) the bullet

> This chapter is an overview of two relatively rare-penetrating spinal cord injuries, their epidemiology, mechanism of injury, initial evaluation, and emergency primary and late definitive treatment. We also reviewed the complication and prognosis of each injury.


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**Table 1.** Summarized table comparing evaluation, treatment, and complications between NMPSCI and MPSCI.

In order to emphasize the differences between these entities, we present a summarized table that compares between them (**Table 1**).
