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Thread: My Story...Acute SCI Level T10/T11

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  1. #1

    My Story...Acute SCI Level T10/T11

    On March 11, 2005 I was shot by an ex-boyfriend of over a year and a half. He had been stalking and harassing me for about 10 months. My worst fear came true on that night of March 11. It was a relatively normal day for me, until I returned to my house that evening. My ex was waiting for me inside my house, he was threatening to kill himself. In the end I was shot in the abdomen and my ex was dead with a self-inflicted gun shot wound.

    I was able to call 911. I first realized I could not feel my legs while waiting for the police and EMS to arrive. I was carried out on a tarp to get to the stretcher and taken to the closest hospital. The next memory I have was coming to in the emergency room, I was in a sitting position and my legs were splayed below me. The last thing I remember was the doctors putting in a chest tube while the flight nurse waited to take me to KU Medical center. I do not remember anything else until I woke up in the ICU. I was in surgery for about 8 hours. The bullet damaged my stomach, diaphragm, lungs and spinal cord. The bullet is still lodged in my body, apparently they thought removing it would cause more damage to my spinal cord.

    I have a lot of resentment towards the neurologist/neuro-surgeon as no one bothered to tell me or my family that I was paralyzed or any of the details as to why. Every day I was in ICU someone touched my foot and asked if I could feel it, I could not and each time replied no. Right before transferring to a regular room, the nurses tracked down someone to tell me my diagnosis, only after much prodding from my family. I was told that I had a complete spinal cord injury and I would never walk again. To this day we don't know who that doctor was...but it was good to finally know. Oddly, I was o.k. with the diagnosis and I was somewhat expecting it. I knew several people who were confined to wheelchairs and I knew they lead full complete lives. It was not the end of the world. To be honest, I was more upset to learn that my dog had been killed by the police as they were trying to get to me.

    I was in the hospital for about 2 1/2 weeks before going to rehab. In that time the neurologist/neuro-surgeon saw me maybe once. Granted I had other health concerns at the time from the surgery but no one really explained anything to me or my family as to the long term prognosis. The physical therapists did work with me while I was there. I had to wear a brace and they would put that on and get me to sit up, chest tubes and all. After my experiences with KUMC I chose to go elsewhere for rehab. I was in the rehab hospital for a week before I went back into the hospital due to complications from an illius as well as pancreatitis and blood clots.

    After 2 1/2 weeks I was well enough to return ro rehab. I was there for a month but was unable to fully complete what I needed to due to the brace. I was sent home until the brace came off. I returned in July and finally learned how to transfer and worked on strengthening my upper body and becoming more independent. I was so glad to leave there being able to do more for myself, and finally give my mom a break. I have been doing outpatient rehab since I left.

    At this point, I still have a lot of questions no one has answered. It doesn't help that I don't always know exactly know what questions to ask either. I spend my free time doing what research I can and that is how I came across this community. I often feel like no one knows what I'm going through but this community reassures me that I'm not alone in my struggle.

    Thank you for listening.

    Jennifer

  2. #2
    Jennifer, thank you for sharing your horrific story....I am so sorry that this happened to you. I am glad you found us though. We are here to offer support and try to answer your questions. Our community is a wealth of experience and wisdom...ask away!

    (KLD)

  3. #3
    Senior Member Jadis's Avatar
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    Jennifer, there are a lot of us on this board with the low level injury as you have. I wish the circumstances were different, but this board is a good place to be..excellent source of support and information.

    make sure that you post questions inthe appropriate forums for care or equipment, etc - those boards are more active and your questions will be seen and answered sooner.


  4. #4
    Bonita (Jennifer),

    Not knowing what you don't know, let me review some literature on the subject and hope that this would stimulate some questions:

    Gunshot Wound Induced Spinal Cord Injury

    Gunshot and violence-induced spinal cord injury account for as much as 5-25% of spinal cord injury. Kitchel (2003) suggested that the incidence of gunshot induced spinal cord injury is increasing. Gur, et al. (2005) assessed the causes of spinal cord injury in southeast Turkey from 1990-1999. Of 539 patients (416 men and 123 women), 37.5% were due to automobile accidents, 31.9% from falls, and 21% from gunshot. But, an earlier study by Karacan, et al. (2000) reported that gunshot wounds accounted for only 2% of spinal cord injuries in Turkey in 1992. In Virginia, of 1290 patients with spinal cord injury seen between January 1997 to December 1999, 48% were due to vehicular accidents, 41% from falls, 6% from recreational injuries or assaults, and 5% from gunshot wounds (Anderson, et al. 2004). In Bangkok, Thailand, nearly 75% were from traffic accidents (49% car and 25% motorcycle), 17% were from falls, and 8% were from gunshot wounds (Kuptniratsaikul, 2003).

    For many years, partly because of the experience in the Vietnam War, doctors were especially pessimistic about prospects of recovery from gunshot induced spinal cord injury. In the 1980's, when we planned the clinical trial that led to the discovery that the high-dose steroid drug methylprednisolone improves functional recovery after spinal cord injury by about 20%, neurosurgeons were so pessimistic about the possibility of any recovery after gunshot-induced spinal cord injury that they argued against including such patients in the clinical trial, saying that such patients would simply drag the statistics down. So, the second National Acute Spinal Cord Injury (NASCIS 2) study did not include patients with gunshot wounds. The third study (NASCIS 3) likewise excluded people with gunshot wounds. But, there other reasons that clinicians did not want to give methylprednisolone.

    Because steroids suppress the immune-system, there were fears that this might leads to infections, particularly if the bullet passed through the intestines. Because we have no data concerning the safety or efficacy of methylprednisolone use in gunshot induced spinal cord injury, at the present, methylprednisolone is not recommended for use in penetrating wounds of the spinal cord (Rosenfeld, 2002). In India, Bhatoe & Singh (2003) described 22 cases of low velocity missile-induced injuries, 18% of which resulted from bullets. They operated on most of the patients and removed the missiles without any incidence of postoperative meningitis or cerebrospinal leak. However, Spitz & Ouban (2003) described a case of death from meningitis following a gunshot wound of the neck, although it was not clear that the patient received methylprednisolone. Flores, et al. (1999) assessed 45 patients who had been operated on after gunshot injuries of the spinal cord and suggested that 70% of the patients experienced pain relief after surgery and methylprednisolone treatments.

    A bullet passing the spinal cord without directly striking it can nevertheless cause spinal cord injury. Mirovsky, et al. (2005) reviewed cases of gunshot induced spinal cord injury between 1977-2003 seen at an Israeli hospital. Of 26 patients, 15 had complete and 11 had incomplete paraplegia. In 3 of the patients with complete paraplegia at the thoracic level, detailed examination of CT and MRI scans, and operative descriptions, did not reveal any compromise of the spinal canal, suggesting that just the kinetic energy of the bullet passing by the spinal cord can cause severe spinal cord injury. Two of these patients had low-velocity bullets that contacted the spinal column while the third had a high-velocity bullet wound that did not. Gunshot wound induced injuries of the spinal column, however, does not always cause spinal cord injury. Klein, et al. (2005) reviewed 2450 patients who were admitted to gunshot wounds of the trunk, neck, or head. Of these patients, 244 (about 10%) had spine injuries. Two thirds of these had significant spinal column injuries without spinal cord injury. In fact, 13% of the patients had unsuspected injuries of the spinal column without spinal cord injury. The authors recommended complete radiographic examination of gunshot wounds of the spinal column to ensure that spine injuries are detected in patients without spinal cord injury. In military gunshot-induced spinal cord injury, high velocity bullets produced more severe injuries (Alaca, et al. 2002).

    Bullet damage to the vertebral column may lead to unstable fracture of the cervical spinal cord. Medzon, et al. (2005) desribed 81 patients who had gunshot wounds of the spinal cord. A third of the patients had unstable cervical fractures that required surgical stabilization. The authors recommended that a cervical collar should not be maintained at the expense of preventing access to or treatment of the wound but that the cervical collars should be used before and after the procedures. Other types of penetrating wounds with knives are not usually associated with spinal column instability. Connell, et al. (2003) in Scotland reviewed 12 cases of spinal cord injury associated with penetrating wounds. Only one of the patients had a gunshot wound and 10 resulted from sharp weapons; 4 had complete cord transections and 9 had partial cord lesions. Cornwell, et al. (2001) reported that thoracolumbar immobilization is almost never beneficial in patients with torso gunshot wounds.

    For many years, when the bullet was still present in the body, especially in the spinal canal, surgeons did not think that surgical removal of the bullet was warranted. However, many surgeons have reported that an intraspinal bullet can migrate and that the bullet should be removed. For example, Kafadar, et al. (2005) in Istanbul described a case of a 44-year old man who had a penetrating gunshot injury at L1, resulting in a complete spinal cord injury. The bullet had migrated to S1-S2 and was removed and the patient did not get any infection after a 17-day course of antibiotic therapy. Waters & Sie (2003) pointed out that gunshot wounds are the second most common cause of spinal cord injury and reported that about a quarter of the patients were able to ambulate at one year after injury and that surgical decompression and removal of bullets improves recovery if the injury is below the T12 level.

    Gunshot induced spinal cord injury does not always induce complete loss of neurological function below the injury site. The demography of gunshot induced spinal cord injury, however, has been changing in the United States. In the past, gunshot wounds typically resulted in mostly complete loss of neurological function below the injury site and over 80% of the victims were male. However, Calancie, et al. (2005) reviewed 229 people in Miami/Dade County who had gunshot wounds leading to spinal cord injury and found a higher percentage of incomplete spinal cord injury and more women. Sacomani, et al. (2003) in Brazil compared bladder function in patients who had gunshot and other causes of spinal cord injury and reported no difference in bladder or sphincteric function and recovery. People with gunshot induced spinal cord injury, however, tend to have more severe neuropathic pain than those with traumatic spinal cord injury (Putzke, et al., 2001a) but otherwise the rehabilitation and recovery of the patients are similar (Putzke, et al. 2001b). Rogano, et al. (2003) described 84 patients with chronic pain associated with spinal cord injury. Although the pain intensity was not associated with the severity or location of injury, more males had pain and the pain tended to be more intense when it was related to gunshot injury.

    In summary, gunshot induced spinal cord injury varies enormously from country to country, ranging from 2-25% of spinal cord injuries. Doctors have been traditionally pessimistic about the outcome from gunshot wounds and while this may be true for gunshot wounds resulting from high velocity bullets, much evidence suggests that low velocity bullets are often associated with incomplete injuries and that the rehabilitation course and recovery does not differ from other causes of spinal cord injury. Methylprednisolone use is currently not recommended for gunshot induced spinal cord injury because there is insufficient data and also because of fears that steroid treatment may increase the risk of infections. The bullet may damage the spinal cord without penetrating the spinal canal. However, a bullet may damage the spinal column without causing spinal cord injury. People with gunshot-induced spinal cord injuries tend to be have more severe neuropathic pain when it occurs but surgical removal of the bullets may reduce such pain.

    References
    • Waters RL and Sie IH (2003). Spinal cord injuries from gunshot wounds to the spine. Clin Orthop Relat Res 120-5. Although vehicular trauma traditionally has accounted for the majority of spinal cord injuries, gunshot wounds are the second most common cause. Furthermore, the proportion of spinal cord injuries caused by gunshot wounds are increasing although the proportion of injuries caused by high-speed vehicular trauma is decreasing. Gunshot wounds to the spine commonly are thought to be stable injuries. There is, however, a potential for instability if the bullet passes transversely through the spinal canal and fractures pedicles and facets. Injuries to the thoracic region of the spine are the most common, followed by the thoracolumbar area and the cervical spine. Completeness of injury is related to the anatomic region. Patients with incomplete injuries and patients with injuries in the thoracolumbar region have the greatest improvement in motor function. Approximately (1/4) of individuals are able to ambulate 1 year after injury. Surgical decompression of bullets from the spinal canal has been shown to improve neurologic recovery below the T12 level. Improvement of neurologic recovery after bullet removal has not been shown in other regions of the spine. Rare instances of late neurologic decline because of retained bullet fragments have been documented. Rancho Los Amigos National Rehabilitation Center, Downey, CA 90242, USA. rwaters@dhs.co.la.ca.us http://www.ncbi.nlm.nih.gov/entrez/q..._uids=12616048
    • Kitchel SH (2003). Current treatment of gunshot wounds to the spine. Clin Orthop Relat Res 115-9. The incidence of spinal cord injury from gunshot wounds in penetrating trauma continues to increase with the violent nature of society. This particularly is true in urban areas, as is found with other violent crime. Either the direct path of the bullet or the concussive effects cause injury to the spine and spinal column. Thorough patient evaluation and appropriate radiographic studies will provide the keys to treatment of these patients. Criteria are given for treatment related to neurologic findings and progressive neurologic evaluation. Infection related to missiles penetrating through the alimentary tract and then lodging in the spine is a relatively rare complication and appropriate standards for debridement and fragment removal are discussed. Principles of treatment in all missile injuries to the spine evolve around spine stability, aggressive rehabilitation, and preservation of neurologic function. Orthopedic Spine Associates, Eugene, OR 97401, USA. http://www.ncbi.nlm.nih.gov/entrez/q..._uids=12616047
    • Gur A, Kemaloglu MS, Cevik R, Sarac AJ, Nas K, Kapukaya A, Sahin H, Guloglu C and Bakir A (2005). Characteristics of traumatic spinal cord injuries in south-eastern Anatolia, Turkey: a comparative approach to 10 years' experience. Int J Rehabil Res 28: 57-62. The purpose of this study was to determine the demographic and epidemiological characteristics of traumatic spinal cord-injured patients. The hospital records of 539 patients (416 men, 123 women) with spinal cord injuries (SCIs) admitted to four hospitals that were major referral centers for trauma in the south-eastern region of Turkey from 1990 to 1999 were reviewed retrospectively. The patients with SCI were investigated for two periods; the first period covered patients admitted between 1990 and 1994 during which time an influx of people from rural to urban areas occurred and firearm injuries were common. In the second period (1995-1999) the influx of people declined and firearm injuries were reduced. The most common causes of injuries were road traffic accidents (200, 37.12%), followed by falls (172, 31.90%) and bullet wounds (115, 21.34%). In the first period, incomplete paraplegia was encountered more often than in the second period (P<0.001). In conclusion, in our series, while the leading cause of SCI for the two time periods was road traffic accidents, firearm injuries for the first period and falls for the second period were second-most frequent causes of SCI. In addition, the present study suggests that demographic and epidemiological factors may affect the characteristics of SCI in a region-based population even in a 10-year period of time. Physical Medicine and Rehabilitation, Dicle University School of Medicine, Diyarbakir, Turkey. alig@dicle.edu.tr http://www.ncbi.nlm.nih.gov/entrez/q..._uids=15729098
    • Karacan I, Koyuncu H, Pekel O, Sumbuloglu G, Kirnap M, Dursun H, Kalkan A, Cengiz A, Yalinkilic A, Unalan HI, Nas K, Orkun S and Tekeoglu I (2000). Traumatic spinal cord injuries in Turkey: a nation-wide epidemiological study. Spinal Cord 38: 697-701. STUDY DESIGN: An epidemiological study conducted all over the country. OBJECTIVE: The present retrospective study was conducted to survey the new traumatic spinal cord injury (SCI) cases during 1992 in Turkey. SETTING: Intensive care units, emergency services and departments of orthopaedic surgery, neurosurgery and rehabilitation of state hospitals, rehabilitation centers, military and university hospitals. METHODS: Postal questionnaires were used for data collection and the records from medical institutes nation-wide were reviewed for the analysis of the epidemiological factors. RESULTS: Five hundred and eighty-one new traumatic SCI cases were reported in 1992. The annual incidence was found to be 12.7 per million population. Male to female ratio was 2.5:1 and the average age at injury was 35.5+/-15.1 (35.4+/-14.8 for males and 35.9+/-16.0 for females). The most common cause of injury was motor vehicle accidents (48.8%) followed by falls (36.5%), stab wounds (3.3%), gunshot injuries (1.9%) and injuries from diving (1.2%). One hundred and eighty-seven patients (32.18%) were tetraplegic and 394 patients (67.8%) were paraplegic. The most common level of injury was C5 among tetraplegics and T12 among paraplegics. The most prevalent associated injury was head trauma followed by extremity fractures. Severe head trauma resulting in death may obscure the real incidence of SCI and may cause underreporting of cases in epidemiological studies. CONCLUSION: Considering that motor vehicle accidents and falls were found to be the leading causes of traumatic SCI, it was concluded that the prevention measures should be focused mainly on these in order to reduce the frequency of SCI in Turkey. Bakirkoy Istanbul, Turkey. http://www.ncbi.nlm.nih.gov/entrez/q..._uids=11114778
    • Anderson SD, Anderson DG and Vaccaro AR (2004). Skeletal fracture demographics in spinal cord-injured patients. Arch Orthop Trauma Surg 124: 193-6. INTRODUCTION: The demographics of skeletal fractures found in patients presenting with a spinal cord injury to a modern level-one trauma center have not been reported. MATERIALS AND METHODS: A retrospective review was performed of 1290 patients presenting between January 1997 and December 1999 with an acute vertebral fracture and spinal cord or cauda equina injury to determine the incidence, fracture type, and mechanism of all fractures of the extremities and pelvis. RESULTS: Overall, 128 (10% of 1290) of these patients sustained 203 associated skeletal fractures including 16 open fractures (8% of 203). The most common associated fractures involved the radius, tibia, femur, humerus, fibula, and ulna. Some 48% of the injuries was due to motor vehicle accidents, 41% to falls, 6% to recreational injuries or assaults, and 5% to gunshot wounds. Twenty-four patients (1.8% of 1290) were found to have more than one vertebral fracture and sustained a high rate of associated fractures (42 fractures), averaging 1.8 fractures per patient. CONCLUSION: This study underscores the frequent association between vertebral fractures and fractures of the appendicular skeleton and pelvis and reinforces the need to maintain a high index of suspicion when evaluating neurologically injured patients due to the potential for symptom masking of acute nonspinal fracture. Department of Orthopaedic Surgery, University of Virginia, School of Medicine, 400 Ray C. Hunt Drive, Suite 330, Charlottesville, VA 22903, USA. http://www.ncbi.nlm.nih.gov/entrez/q..._uids=15067551
    • Kuptniratsaikul V (2003). Epidemiology of spinal cord injuries: a study in the Spinal Unit, Siriraj Hospital, Thailand, 1997-2000. J Med Assoc Thai 86: 1116-21. A prospective study of 83 patients with spinal cord injuries admitted to the Spinal Unit, Siriraj Hospital, Bangkok, Thailand from January 1997 to December 2000 was conducted. The average age was 33.2 +/- 11.7 years (range from 10 to 68 years) with a male: female ratio of 4 : 1. Most subjects (83.2%) were aged between 16-45 years. About half of them had no associated injuries and no financial problems. Three-fourths of the spinal injuries were caused by traffic accidents (49.4 and 25.3% car and motorcycle respectively). The other two causes were falls (16.9%) and gunshot wounds (8.4%). The neurological classification was as follows: 34 (41.0%) patients had ASIA D grade of injury, 28 (33.7%) were paraplegic with ASIA A, B or C grade and 21 (25.3%) were tetraplegic with ASIA A, B, or C grade. Traffic accidents most frequently resulted in an incomplete ASIA D grade (40.3%). Males were more predominant for all causes of injury especially motorcycle accidents. The average Barthel Index score was 24.3 +/- 24.7 and 51.9 +/- 31.8 at admission and discharge respectively. The prevalence of depression was 24.1 per cent. The average length of stay for the depressed and non-depressed groups was 117.4 +/- 59.1 and 73.4 +/- 54.4 days respectively. Department of Rehabilitation, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand. http://www.ncbi.nlm.nih.gov/entrez/q..._uids=14971518
    • Rosenfeld JV (2002). Gunshot injury to the head and spine. J Clin Neurosci 9: 9-16. The principles of management of civilian gunshot wounds (GSWs) to the head and spine have evolved directly from the experience gained in war by military neurosurgeons. The type of craniocerebral wounds being produced in urban gang warfare and suicide at tempts using handguns or rifles at close range vary considerably from the lower velocity fragment injuries which are common in modern warfare. Civilian craniocerebral GSWs are often devastating. The in-hospital mortality for civilians with penetrating craniocerebral injury is 52-95% depending on the proportion of suicide victims in the series. The most important predictive factor is the post-resuscitation Glasgow Coma Score (GCS). Many civilian victims (47%) present with GCS 3-5 and only approximately 8.1% survive. Of these survivors, 1.4% will have nil, mild or moderate disability without surgery and 4.8% with surgery. Higher post-resuscitation GCS is associated with a significantly improved survival: GCS 6-8, 35.6% and GCS 9-15, 90.5%. A selective treatment policy is recommended for the patients with GCS 3-5. There are many clinical and radiological correlates with poor outcome that help the neurosurgeon decide on operative versus supportive treatment. Early aggressive resuscitation, surgery and vigorous control of intracranial pressure offers the best chance of achieving a satisfactory outcome. Spinal GSWs are uncommon and the neurosurgeon should be aware of the principles of management and prognosis. The indication for acute spinal cord decompression is deteriorating neurological status. Steroids are not indicated for these injuries. Neurosurgeons should take an active role in formulating and supporting public policy which aims to reduce possession and usage of firearms and therefore the prevalence of gunshot injuries. Department of Neurosurgery, the Alfred Hospital and Monash University, Australia. http://www.ncbi.nlm.nih.gov/entrez/q..._uids=11749010
    • Bhatoe HS and Singh P (2003). Missile injuries of the spine. Neurol India 51: 507-11. Between 1995 and 2000, 22 cases with low velocity missile injuries of the spine and spinal cord were treated in three service hospitals. All were adult males, with a mean age of 30.7 years. The wounds were caused by splinters in 18 (82%) and bullets in 4 (18%). Twelve patients received more than one splinter. The cervical and thoracic spines were most frequently involved. In 7 cases, there were injuries to other organs. There was extensive initial deficit (quadriplegia, paraplegia) in 18 (82%) cases, while 4 (18%) had partial deficits. The patients were evaluated by spine radiographs. Myelography was done in 4, CT myelography in 11 and MRI in 4 patients. Two patients had intramedullary hematoma without any skeletal injury, and were treated conservatively. Seventeen patients were treated operatively, and associated injuries of other organs received priority management. Surgery was in the form of debridement, exploration of the spinal cord, hemostasis, decompression and dural repair. Steroids and antibiotics were given routinely. Three patients (2 with cervical and 1 with thoracic spine injury) died preoperatively, and 1 (with dorsolumbar injury) died in the postoperative period due to multi-organ injury. Patients with complete injury remained completely paralyzed, while those with an incomplete injury showed improvement in their neurological grades. The initial neurological grade is the best prognostic indicator, and these injuries are often accompanied by multi-organ injuries. There was no instance of postoperative meningitis or CSF leak. These injuries should be explored for debridement and dural repair. Department of Neurosurgery, Army Hospital (R & R), Delhi Cantt-110010, India. hsbhatoe@indiatimes.com http://www.ncbi.nlm.nih.gov/entrez/q..._uids=14742934
    • Spitz DJ and Ouban A (2003). Meningitis following gunshot wound of the neck. J Forensic Sci 48: 1369-70. It is generally assumed that a missile fired from a gun is subjected to sufficient heat to render it sterilized. For this reason, retained bullets are not usually considered a source of infection. The infectious complications associated with gunshot wounds are typically attributed to perforation of a hollow viscus with leakage of gastrointestinal contents causing peritonitis or intra-abdominal abscess. There are several reports of bacterial meningitis involving the spinal cord in gunshot wounds that perforate the intestine prior to involving the thoracic or lumbar vertebral column; however, there are no published reports of cerebral meningitis resulting from a retained projectile in the spinal canal in which there was no injury to the gastrointestinal tract. This manuscript describes a woman who died as a result of unsuspected acute bacterial meningitis which developed secondary to a gunshot wound of the neck. The projectile fractured the first thoracic vertebra, lacerated the dura and contused the spinal cord at the C7-T1 junction. Meningitis developed at the C7-T1 level and ascended along the cervical spinal cord to the brain. The infection caused acute neurologic deterioration and death four days following the initial injury. Hillsborough County Medical Examiner Department, Tampa, FL 33602, USA. http://www.ncbi.nlm.nih.gov/entrez/q..._uids=14640287
    • Flores LP, Nascimento Filho Jde S, Pereira Neto A and Suzuki K (1999). [Prognostic factors related to gunshot wounds to the spine in patients submitted to laminectomy]. Arq Neuropsiquiatr 57: 836-42. The spinal trauma related to civilian gunshot missile still remains a serious neurological event that carries a dismal prognosis almost in all cases. Its surgical indication also is a matter of discussion. Our goal is to identify the aspects that could influence the prognosis after surgery to this kind of lesions. We conducted a retrospective study of 45 consecutive patients submitted to laminectomy at Hospital de Base do Distrito Federal (Brasilia, Brazil), testing the following aspects: initial neurological status, level of the deficit, surgical timing, use of methilprednisolone and presence of dural tearing. Among those, the initial clinical presentation and the level of the lesion (60% of the patients with cauda equina syndrome and 53% of that with lesions in the lombar region improved their neurological status after laminectomy) were the most important factors affecting the outcome. Seventy percent of the patients experienced a pain relief after the surgical procedure. Unidade de Neurocirurgia do Hospital de Base do Distrito Federal, Brasilia, DF. ifneiva@nutecnet.com.br http://www.ncbi.nlm.nih.gov/entrez/q..._uids=10751920
    • Mirovsky Y, Shalmon E, Blankstein A and Halperin N (2005). Complete paraplegia following gunshot injury without direct trauma to the cord. Spine. 30: 2436-8. Spine Unit, Assaf Harofeh Medical Center, Zerifin, Israel. Mirovsky@netvision.net.il. STUDY DESIGN: A retrospective review of all patients with neurologic deficit following gunshot wounds that did not penetrate the spinal canal. OBJECTIVES: To evaluate the possibility that neurologic deficit following gunshot wounds is possible without direct trauma to the cord. SUMMARY OF BACKGROUND DATA: Gunshot injuries to the spine account for 13% to 17% of all spinal cord injuries and are likely to result in complete paraplegia. Neurologic deficit is the result of direct trauma to the nervous tissue by the bullet, bone, or disc fragments, which compress the cord. METHODS: The medical charts, radiographs, CT scans, and myelographies or MRIs of all patients admitted to our hospital with neurologic deficit secondary to gunshot wounds between 1977 and 2003 were reviewed. Twenty-six patients were identified: 15 with complete and 11 with incomplete paraplegia. In 19 patients, the spinal canal at the level of injury was explored and decompressed. RESULTS: In 3 patients with complete paraplegia at the thoracic level, CT scan, myelography (1 patient), MRI (2 patients), and operative exploration (2 patients) did not indicate any signs of canal compromise. Two were injured by low-velocity bullets passing through the vertebra (in 1 patient) and the posterior part of the lamina (in the second). The third was injured by high-velocity bullets with no signs on MRI of any injury to the vertebral column or spinal cord. At follow-up 4.1 years later, on average, none had any neurologic recovery. CONCLUSION: Neurologic deficit following gunshot wounds is possible even without violation of the spinal canal. It is most probably the result of the kinetic energy emitted by the bullet.
    • Medzon R, Rothenhaus T, Bono CM, Grindlinger G and Rathlev NK (2005). Stability of cervical spine fractures after gunshot wounds to the head and neck. Spine. 30: 2274-9. Department of Orthopaedic Surgery and Emergency Medicine, Boston Medical Center, Boston, MA 02118-2393, USA. STUDY DESIGN: Retrospective chart review. OBJECTIVES: To determine the frequency of stable and unstable cervical spine fractures after gunshot wounds to the head or neck; to identify potential risk factor(s) for an unstable versus stable cervical spine fracture. SUMMARY OF BACKGROUND DATA: Cervical spine fractures after gunshot wounds to the head and neck are common. Because of the nature of their injuries, patients often present with concomitant airway obstruction and large blood vessel injury that can necessitate emergent procedures. In some cases, acute treatment of these problems can be hindered by the presence of a cervical collar or strict adherence to spinal precautions (i.e., patient laying supine). In such situations, information regarding the probability of a stable versus unstable cervical spine fracture would be useful in emergency treatment decision making. METHODS: A search for patients with gunshot wounds to the head or neck potentially involving the cervical spine over a 13-year period was performed using a trauma registry. Individuals with cervical spine fractures were identified and their records reviewed in detail. Data collected included information about neurologic deficits, mental status, airway treatment, entrance wounds, fracture level/type, initial/definitive fracture treatment, and final disposition at hospital discharge. RESULTS: A total of 81 patients were identified; 19 had cervical spine fractures. There were 5 patients who were not examinable because of altered mental status (severe head trauma, hemorrhagic shock, or intoxication). All 5 patients had stable cervical spine fractures. There were 11 patients who had an acute spinal cord injury, 3 (30%) of whom underwent surgery for an unstable fracture. Of the 65 awake, alert patients without a neurologic deficit, only 3 (5%) had a fracture, none of which were unstable. CONCLUSIONS: Gunshot wounds to the head and neck had a high rate of concomitant cervical spine fracture. Neurologically intact patients have a lower rate of fracture than those presenting with a spinal cord injury or altered mental status. In this small series of patients, the only unstable cervical spine injuries were detected in patients with a spinal cord injury. The data suggest that spinal precautions and/or a hard cervical collar should not be maintained at the expense of delaying or hindering emergent life-saving airway or hemodynamically stabilizing procedures, particularly in awake, neurologically intact patients. However, the cervical collar and spinal precautions should be resumed after such procedures are completed and continued until a more definitive evaluation of spinal stability can be performed.
    • Connell RA, Graham CA and Munro PT (2003). Is spinal immobilisation necessary for all patients sustaining isolated penetrating trauma? Injury 34: 912-4. INTRODUCTION: Previous work suggests that patients with isolated penetrating trauma rarely require spinal immobilisation. This study aimed to identify the incidence of mechanically unstable, or potentially mechanically unstable, spinal column injuries in penetrating trauma patients. The study also aimed to identify the incidence of spinal cord injury as a result of penetrating trauma in Scotland. DESIGN: Retrospective analysis of prospectively collected data from the Scottish Trauma Audit Group (STAG). METHODS: Study patients were identified from the period 1992-1999. Patients coded for both penetrating trauma and spinal column or spinal cord injury were included. Case records, theatre notes and post mortem information were also examined. RESULTS: 34903 patients were available for study. Twenty-seven patients were coded as having had penetrating trauma and concurrent spinal injury. 15 were excluded as they also had a major blunt mechanism of injury or had no actual injury to the spinal cord or column. In the remaining 12 patients, four cervical, one combined cervical and thoracic and seven thoracic spinal cord injuries were identified. 11 were male and 11 were assaulted. One assault was due to a gunshot wound; 10 resulted from sharp weapons. Four complete cord transections and nine partial cord lesions were identified. All 12 patients with spinal cord injury associated with isolated penetrating trauma either had obvious clinical evidence of a spinal cord injury on initial assessment or were in traumatic cardiac arrest. All had spinal immobilisation. CONCLUSION: Fully conscious patients (GCS=15) with isolated penetrating trauma and no neurological deficit do not require spinal immobilisation. Department of Accident & Emergency Medicine, Southern General Hospital, 1345 Govan Road, Glasgow G51 4TF, UK. http://www.ncbi.nlm.nih.gov/entrez/q..._uids=14636733
    • Cornwell EE, 3rd, Chang DC, Bonar JP, Campbell KA, Phillips J, Lipsett P, Scalea T and Bass R (2001). Thoracolumbar immobilization for trauma patients with torso gunshot wounds: is it necessary? Arch Surg 136: 324-7. BACKGROUND: Previous studies have suggested that patients transported by emergency medical services (EMS) following major trauma had a longer injury-to-treatment interval and a higher mortality rate than their non-EMS-transported counterparts. HYPOTHESIS: There is little actual benefit of thoracolumbar immobilization for patients with torso gunshot wounds (GSW). DESIGN: Retrospective analysis of prospectively gathered data from the Maryland Institute for Emergency Medical Service Systems State Trauma Registry from July 1, 1995, through June 30, 1998. SETTINGS: All designated trauma centers in Maryland. PATIENTS: All patients with torso GSW. MAIN OUTCOME MEASURES: (1) A patient was considered to have benefited from immobilization if he or she had less than complete neurologic deficits in the presence of an unstable vertebral column, as shown by the need for operative stabilization of the vertebral column; (2) mortality. RESULTS: There were 1000 patients with torso GSW. Among them, 141 patients (14.1%) had vertebral column and/or spinal cord injuries. Two patients (0.2%) (95% confidence interval, -0.077% to 0.48%) required operative vertebral column stabilization, while 6 others required other spinal operations for decompression and/or foreign body removal. The presence of vertebral column injury was actually associated with lower mortality (7.1% vs 14.8%, P<.02). CONCLUSIONS: This study suggests that thoracolumbar immobilization is almost never beneficial in patients with torso GSW, and that a higher mortality rate existed among those GSW patients without vertebral column injury vs those with such injuries. The role of formal thoracolumbar immobilization for patients with torso GSW should be reexamined. Department of Surgery, The Johns Hopkins Medical Institutions, 600 N Wolfe St, Osler 625, Baltimore, MD 21287-5675, USA. ecornwel@jhmi.edu http://www.ncbi.nlm.nih.gov/entrez/q..._uids=11231854
    • Kafadar AM, Kemerdere R, Isler C and Hanci M (2005). Intradural migration of a bullet following spinal gunshot injury. Spinal Cord Study design:Case report.Objectives:To report a penetrating gunshot injury at L1 with migration within the spinal canal to S2.Setting:Istanbul, Turkey.Methods:A 44-year-old man was admitted with an entrance gunshot wound on the left upper quadrant. An emergency exploratory laparotomy with left nephrectomy and transverse colon repair were performed. He had complete spinal cord injury below the level of L1. Lumbar magnetic resonance imaging (MRI) revealed hemorrhagic areas in conus medullaris and L1 corpus. The bullet was lodged at the S2 level. S1-S2 laminectomies were performed for the removal of the bullet. The antibiotic therapy was given for 17 days.Results:No meningitis or wound infection was observed after the operation. At discharge his neurological status was improved.Conclusions:The present case presented the movement of an intraspinal bullet after a spinal gunshot injury. No signs of infection were detected postoperatively. Lumbar MRI was used safely without any change in neurological status or patient discomfort.Spinal Cord advance online publication, 20 September 2005; doi:10.1038/sj.sc.3101808. 1Department of Neurosurgery, Cerrahpasa Medical School, Istanbul University, Cerrahpasa, Istanbul, Turkey. http://www.ncbi.nlm.nih.gov/entrez/q..._uids=16172630
    • Klein Y, Cohn SM, Soffer D, Lynn M, Shaw CM and Hasharoni A (2005). Spine injuries are common among asymptomatic patients after gunshot wounds. J Trauma 58: 833-6. BACKGROUND: Spine injuries after gunshot wounds are thought to be rare among asymptomatic patients. The occurrence of spine injuries among asymptomatic patients with gunshot wounds was studied to determine the necessity for mandatory spine immobilization and radiographic imaging. METHODS: In this retrospective cohort study, initial physical examination, radiographic findings, and final diagnosis and treatment were reviewed. Patients were included if they were admitted to the authors' level 1 trauma center with gunshot wounds to the head, neck, or trunk during a 10-year period. Spine injuries were considered "significant" if the injury was associated with spinal cord injury or required spine-related surgical procedures or prolonged spine immobilization. Spine injuries were defined as "unsuspected" if there were no neurologic findings at admission. RESULTS: During the study period, 2,450 patients who survived more than 24 hours were admitted with gunshot wounds to the trunk, neck, or head. Of these patients, 244 (approximately 10%) had spine injuries, and 228 of them had complete records. Two thirds of the spine injuries were found to be significant, requiring surgery or prolonged immobilization, and 13% were unsuspected. CONCLUSIONS: Spine injuries without neurologic signs are not uncommon among patients with gunshot wounds. Complete radiographic spine imaging is therefore recommended to ensure that spine injuries are not missed in this population. Divisions of Trauma and Surgical Critical Care, University of Miami School of Medicine, Miami, Florida, USA. yoramkl@clalit.org.il http://www.ncbi.nlm.nih.gov/entrez/q..._uids=15824664
    • Alaca R, Yilmaz B, Goktepe AS, Yazicioglu K and Gunduz S (2002). Military gunshot wound-induced spinal cord injuries. Mil Med 167: 926-8. Gunshot wounds are the second leading cause of spinal cord injuries in developed countries, whereas in undeveloped and developing countries, this likelihood is much more. However, the weapon and injury characteristics are very different between those two groups of countries. The aim of this study was to review our experience with gunshot wound-caused spinal cord injury during our struggle with terrorism, to examine surgical and medical complications, and to determine the difference between civilian and military gunshot wounds. One hundred five male patients (mean, 25 years of age) were examined according to completeness, spinal and nonspinal injuries, American Spinal Injury Association classification, motor and pinprick scores, surgical and nonsurgical interventions, surgical complications, and spinal cord injury-related medical complications. This study has shown that the likelihood of completeness was higher in gunshot wounds with high velocity weapons. Because of their higher wounding capacity, the difference between vertebral and neurological levels was not very different as it was on the other etiologies. Fortunately, spinal cord injury-related medical complications were less than expected. Turkish Armed Forces Rehabilitation and Care Center, Department of Physical Medicine and Rehabilitation Gulhane Military Medical Academy, Bilkent, Ankara. ridvanalaca@hotmail.com http://www.ncbi.nlm.nih.gov/entrez/q..._uids=12448620
    • Calancie B, Molano MR and Broton JG (2005). Epidemiology and demography of acute spinal cord injury in a large urban setting. J Spinal Cord Med 28: 92-6. OBJECTIVE: In a large, single-center study of subjects with acute traumatic spinal cord injury (SCI), we describe the sample population with respect to gender, age, cause of injury, and severity of injury, to see whether these properties are similar to those of other large-scale studies of acute SCI conducted in the past. METHODS: As part of a study to examine the natural pattern of recovery after acute SCI (presented elsewhere), descriptive information was gathered in relation to subject population and injury properties. RESULTS: A total of 229 subjects were recruited. The study population had a higher percentage of women and a higher mean age of men and women than those of most other published studies of acute SCI. A greater percentage of incomplete subjects was also encountered. The incidence of gunshot injury as a cause of SCI was considerably lower in this study than had been the case 10 years previously in Dade County, Florida. CONCLUSIONS: The demography of acute SCI within a major urban center of South Florida suggests a trend toward less severe injury than in years past. These findings support the development of animal models for testing SCI treatment that include cohorts having mild to moderate injury severity, in order to achieve greater clinical relevance. The Miami Project to Cure Paralysis, Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida 13210, USA. calancib@upstate.edu http://www.ncbi.nlm.nih.gov/entrez/q..._uids=15889695
    • Sacomani CA, Trigo-Rocha FE, Gomes CM, Greve JA, Barros TE and Arap S (2003). Effect of the trauma mechanism on the bladder-sphincteric behavior after spinal cord injury. Spinal Cord 41: 12-5. STUDY DESIGN: Retrospective study. OBJECTIVE: To determine if spinal cord injuries due to gunshot wounds (GW) are associated with different bladder and sphincteric behavior compared to other trauma mechanisms. SETTING: Spinal injury center, Brazilian university hospital. METHODS: We retrospectively evaluated the records and urodynamic studies of 71 patients with spinal cord injury (SCI) referred to the Brazilian National Spinal Cord Injury Center over the year 2000, and compared the bladder-sphincteric pattern of patients with injuries caused by GW with those caused by other trauma mechanisms. RESULTS: The causes of SCI were (1) gunshot wounds (31 patients: 43.7%); (2) motor vehicle accidents (16 patients: 22.5%); (3) falls (16 patients: 22.5%) and (4) diving (three patients: 4.2%). In five patients (7.1%) the causes were unusual trauma mechanisms like stab wound (one patient) and direct trauma in vigorous sports (two patients) or fights (two patients). The levels of the injuries were cervical in 22 patients (31.0%), thoracic in 39 (54.9%) and lumbar in 10 (14.1%). Detrusor hyperreflexia with detrusor-sphincter dyssynergia was present in 65% of the patients overall and in 76% of the thoracic gunshot wounded. Areflexia occurred in 20% of the patients and in 16% of thoracic injured patients with gunshots. Detrusor hyperreflexia with detrusor-sphincter dyssynergia was the pattern encountered in 50% of the individuals suffering from SCI because of other mechanisms and areflexia was present in 35.8%. There was no statistical difference between GW patients and other mechanisms according to bladder and sphincter functions. CONCLUSIONS: There was a substantial overlap of bladder and sphincteric behaviors between patients with different levels of spinal injuries, but the trauma mechanism was not important to determine the bladder and sphincteric functions. Division of Urology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil. http://www.ncbi.nlm.nih.gov/entrez/q..._uids=12494315
    • Rogano L, Teixeira MJ and Lepski G (2003). Chronic pain after spinal cord injury: clinical characteristics. Stereotact Funct Neurosurg 81: 65-9. The clinical characteristics of chronic pain in spinal cord injury patients are controversial. The authors prospectively evaluated 81 patients with chronic pain due to spinal cord lesions. The mean pain intensity according to the visual analogue scale was 9.4. The most common description of pain was a sensation of burning. The initial pain was more severe in patients presenting with myelopathy due to gunshot injuries (p < 0.001). The pain intensity was not associated with the magnitude of the spinal lesion, location of the lesion, occurrence of myofascial pain syndrome or onset of pain. Pain after spinal cord injury was severe, males were more frequently affected and it was more intense when it was the result of gunshot injury. In about 38% of the patients, pharmacological and rehabilitative procedures were effective. Dorsal root entry zone lesion was effective for the treatment of transitional pain in patients with complete section of the spinal cord, spinal cord stimulation was effective for patients with partial lesions of the spinal cord and intrathecal opioid infusion was effective for both conditions. Division of Functional Neurosurgery, Department of Neurology, University of Sao Paulo Medical School, Sao Paulo, Brazil. http://www.ncbi.nlm.nih.gov/entrez/q..._uids=14742966
    • Putzke JD, Richards JS and DeVivo MJ (2001a). Quality of life after spinal cord injury caused by gunshot. Arch Phys Med Rehabil 82: 949-54. OBJECTIVE: To determine what effect gunshot-caused spinal cord injury (SCI) has on self-reported quality of life (QOL) and on the frequency of pain sufficient to interfere with day-to-day activities. DESIGN: Follow-up, case-control design. SETTING: Analysis of data obtained from the (US) National Spinal Cord Injury Statistical Center from 18 funded Spinal Cord Injury Model Systems. PARTICIPANTS: Individuals with traumatic onset SCI (n = 1901). From these, 111 persons with gunshot-caused SCI were matched to persons with nongunshot SCI. MAIN OUTCOME MEASURES: Satisfaction with Life Scale (SWLS), the Craig Handicap Assessment and Reporting Technique (CHART), Medical Outcomes Study Short-Form Health Survey (SF-12), and an individual pain item from the SF-12. RESULTS: No between-group differences were found on any of the QOL outcome measures. In contrast, those with SCI caused by gunshot reported that pain more frequently interfered with day-to-day activities than the matched comparison group. CONCLUSIONS: SCI caused by gunshot appears largely unrelated to QOL, after controlling for demographic and medical characteristics associated with this group. Gunshot as a mechanism of SCI may place individuals at an increased risk of subsequent development of pain that interferes with activities of daily living. Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, USA. http://www.ncbi.nlm.nih.gov/entrez/q..._uids=11441384
    • Putzke JD, Richards JS and Devivo MJ (2001b). Gunshot versus nongunshot spinal cord injury: acute care and rehabilitation outcomes. Am J Phys Med Rehabil 80: 366-70; quiz 371-3, 387. OBJECTIVE: To examine the impact of gunshot-caused spinal cord injury on acute and rehabilitative care outcome using a case control design. DESIGN: Two groups (i.e., gunshot- vs. nongunshot-caused spinal cord injury) of 212 individuals were matched case-for-case on age (i.e., within 10 yr), education, gender, race, marital status, primary occupation, impairment level, and Model System region. Outcome measures included length of hospital stay, functional status (FIM), treatment charges, and home discharge rates. RESULTS: The two groups did not differ in the length of stay during acute and rehabilitative care, charges during rehabilitative care, or postrehabilitation discharge placement. Several significant between-group differences in treatment procedures were noted (e.g., prevalence of spinal surgery), which may, in part, account for the higher acute-care charges among those persons with nongunshot-caused spinal cord injury. CONCLUSION: Once an individual is stabilized and admitted for rehabilitative care, gunshot etiology of spinal cord injury seems largely unrelated to the initial rehabilitation outcome. Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, USA. http://www.ncbi.nlm.nih.gov/entrez/q..._uids=11327559

  5. #5
    Senior Member queen's Avatar
    Join Date
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    Garden on the Green, Indiana
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    Bonita, Welcome to CC
    We're so sad your here, but happy you found us under the circumstances!
    There is absolutely nothing that you can't ask in here as you undertake all
    the gifts that 'sci' keeps on giving. I fell in May 04, and didn't find this
    place til Feb. 05.) A lot of wasted time and information I could have used.

    If you need to vent your anger, frustration, you can do that too as all of us have been there!

    Queen

    p.s. I'm sorry you had to lose your beloved pet and protector that way too.
    Your life is what you make it, and only you have that choice!

  6. #6

    Smile Thank You!

    I just wanted to thank you all for your support and helpful information.

  7. #7

    hi there

    dont give up hope.They hv just done a successful stem cell in india and the man walked.so there is hope,never give it up












    Quote Originally Posted by Bonita
    On March 11, 2005 I was shot by an ex-boyfriend of over a year and a half. He had been stalking and harassing me for about 10 months. My worst fear came true on that night of March 11. It was a relatively normal day for me, until I returned to my house that evening. My ex was waiting for me inside my house, he was threatening to kill himself. In the end I was shot in the abdomen and my ex was dead with a self-inflicted gun shot wound.

    I was able to call 911. I first realized I could not feel my legs while waiting for the police and EMS to arrive. I was carried out on a tarp to get to the stretcher and taken to the closest hospital. The next memory I have was coming to in the emergency room, I was in a sitting position and my legs were splayed below me. The last thing I remember was the doctors putting in a chest tube while the flight nurse waited to take me to KU Medical center. I do not remember anything else until I woke up in the ICU. I was in surgery for about 8 hours. The bullet damaged my stomach, diaphragm, lungs and spinal cord. The bullet is still lodged in my body, apparently they thought removing it would cause more damage to my spinal cord.

    I have a lot of resentment towards the neurologist/neuro-surgeon as no one bothered to tell me or my family that I was paralyzed or any of the details as to why. Every day I was in ICU someone touched my foot and asked if I could feel it, I could not and each time replied no. Right before transferring to a regular room, the nurses tracked down someone to tell me my diagnosis, only after much prodding from my family. I was told that I had a complete spinal cord injury and I would never walk again. To this day we don't know who that doctor was...but it was good to finally know. Oddly, I was o.k. with the diagnosis and I was somewhat expecting it. I knew several people who were confined to wheelchairs and I knew they lead full complete lives. It was not the end of the world. To be honest, I was more upset to learn that my dog had been killed by the police as they were trying to get to me.

    I was in the hospital for about 2 1/2 weeks before going to rehab. In that time the neurologist/neuro-surgeon saw me maybe once. Granted I had other health concerns at the time from the surgery but no one really explained anything to me or my family as to the long term prognosis. The physical therapists did work with me while I was there. I had to wear a brace and they would put that on and get me to sit up, chest tubes and all. After my experiences with KUMC I chose to go elsewhere for rehab. I was in the rehab hospital for a week before I went back into the hospital due to complications from an illius as well as pancreatitis and blood clots.

    After 2 1/2 weeks I was well enough to return ro rehab. I was there for a month but was unable to fully complete what I needed to due to the brace. I was sent home until the brace came off. I returned in July and finally learned how to transfer and worked on strengthening my upper body and becoming more independent. I was so glad to leave there being able to do more for myself, and finally give my mom a break. I have been doing outpatient rehab since I left.

    At this point, I still have a lot of questions no one has answered. It doesn't help that I don't always know exactly know what questions to ask either. I spend my free time doing what research I can and that is how I came across this community. I often feel like no one knows what I'm going through but this community reassures me that I'm not alone in my struggle.

    Thank you for listening.

    Jennifer

  8. #8
    Bonita

    Welcome to this site, hope you will find the answers to your questions.
    My son was shot in the back 4 1/2 years ago, he is T4-5 complete.

  9. #9
    Not sure why this 2 year old post was pulled up again.

    (KLD)

  10. #10
    Senior Member
    Join Date
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    Norway
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    17,427
    Quote Originally Posted by SCI-Nurse
    Not sure why this 2 year old post was pulled up again.

    (KLD)
    I think it is because spam posts makes a post, then when the spam post is removed by a webmaster/mods etc. the post (thread) will stay there (as a recent commented one) without the original spam post. I figure there was a spam post in this thread before post 7.

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