Minimally invasive approach to cervical intraspinal air gun pellet in a pediatric patient.

backgroundThe authors report a case of a 12-year-old girl who presented for neurosurgical evaluation one month after sustaining a ballistic injury to the anterior left side of her neck from a pellet gun accidental firing. Immediately following the misfire, the patient experienced pain in the left side of her neck that radiated to her shoulder, down her posterior arm, and to her middle fingers on the left hand. Subsequently, the patient experienced lingering numbness and developed progressive weakness in her left arm. The patient denied trouble swallowing or any other deficits. Radiographic studies of the cervical spine revealed a ballistic fragment lodged in the C6-7 left foramen, and surgical removal was offered considering debilitating neurological deficits and pain. Preoperative imaging including cervical x-rays and CT of the neck were obtained. A posterior left-sided C6-C7 minimally invasive tubular hemilamino-foraminotomy was performed. The projectile was successfully retrieved, and the C7 nerve root was decompressed and preserved. OBSERVATIONS: Postoperatively, the patient regained normal strength and function of the left hand and continues to report satisfaction with the surgical outcome. LESSONS: This case presentation highlights the surgical management of a C7 radiculopathy due to a retained foreign body in a pediatric patient from a pellet gun accident. It highlights the importance of careful preoperative planning to determine the safest, most efficient, and minimally invasive surgical approach.