The Effect of Surgically Implanted Metallic Bullet Fragments on the Intervertebral Disc Using a Canine Model

Publication date: Available online 18 September 2018

Source: The Spine Journal

Author(s): Nathaniel L. Tindel, Mitchell F. Reiter, Wayne B. Cohen-Levy, Brian Zafonte, Kresimir Banovac, Frank J. Eismont

Abstract

Purpose

To characterize the gross, histologic and systemic changes caused by implantation of metal fragments commonly used in commercial bullets into the intervertebral disc.

Background Context

Long-term complications of retained bullet fragments in the spine have been documented in the literature however the impact of different metal projectiles on the intervertebral disc has not been described. This study was performed to assess the local effects of the metallic bullet fragments on the intervertebral disc and their systemic effects regarding metal ion concentrations in serum and solid organs.

Study Design

: Animal Model Study

Methods

Funding for this project was provided by the Cervical Spine Research Society in the amount of $10,000. Copper, lead and aluminum alloys from commercially available bullets were surgically implanted into sequential intervertebral discs in the lumbar spine of six canines. Kirschner wire implantation and a sham operation were performed as controls. Radiographs were performed to confirm the location of the bullets. Animals were sacrificed at four, six and nine months post-implantation. Whole blood, plasma, cerebrospinal fluid, kidney tissue and liver tissue samples were analyzed for copper and lead concentrations. Histologic and gross samples were examined at the time of sacrifice.

Results

Significant tissue reactions were noted in the discs exposed to copper and lead. Copper resulted in significantly more severe disc degeneration than either the lead or aluminum alloy. In the short interval follow up of this study, no statistically significant trend was observed in whole blood, plasma, CSF and tissue levels.

Conclusion

This study demonstrates that the canine intervertebral disc is differentially susceptible to metallic fragments depending on the composition. Trends were noted for increasing levels of lead and copper in liver tissue samples although statistical significance could not be reached due to short time interval and small sample size. The metallic composition of retained fragments can be a determining factor in deciding on surgical intervention.

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