Retention or Retrieval: A dilemma in a Case of Pediatric Cervical Spine Penetrating Injury from an Air Gun Pellet.

Introduction: Airgun or air-rifle injuries are often perceived as minor injuries; however, they can cause significant morbidity, particularly in children. The cervical spine, with its vital neurovascular and airway structures around, is vulnerable to any penetrating injury, even to low-velocity projectiles. Case Report: We report the case of a 9-year-old boy who sustained an accidental posterior cervical airgun injury at home. The child was neurologically intact, and imaging revealed a retained metallic pellet deeply embedded in the posterior aspect of the neck impacted within the edge of the right lateral mass of the C7 vertebra without involvement of the spinal canal or injury to major vessels. Multiple unsuccessful retrieval attempts were performed at the district hospital before the pellet was successfully removed surgically at our tertiary care institute. The post-operative course was uneventful, and the child remained asymptomatic on follow-up. Conclusion: Pediatric cervical airgun injuries, though often considered minor, can endanger vital cervical structures. Even in neurologically intact patients, retained projectiles may warrant surgical removal when safely accessible to prevent delayed complications such as infection or migration. This case underscores the principle of decision-making beyond deficits, where management is guided by anatomical risk, long-term safety, and the imperative to raise public awareness about the potential dangers of airguns in children.