Spontaneous migration of foreign bodies in the spinal canal has been described, which may be associated with the onset of new neurological symptoms or signs. Surgical removal may be necessary several years after the original injury.1

A 16-year-old man presented to our emergency department with a gunshot wound to the neck. He had spinal cord damage at the level of C2 with a consequent tetraplegia and required ventilatory support. Neurological improvement followed over a period of months. Subsequent imaging of his chest, however, showed the bullet to be rotating and migrating caudally in the spinal canal (fig 1).

• Download figure
• Open in new tab
• Download powerpoint

Figure 1 Initial and subsequent positions of bullet in the spinal canal.

Our patient continued to improve. However, it is important to be aware that if a foreign body is not surgically removed, any unexplained change in neurological symptoms or signs must be investigated immediately, even if this occurs some time after the initial injury, and surgical removal needs to be considered.