A rare case of intraspinal penetrating rubber bullet injury causing thecal sac tear: Surgical extraction with neurological recovery

Penetrating spinal trauma is most commonly associated with metallic projectiles, which are easily visualized on radiographs and CT scans. Rubber bullets, although considered “less-lethal,” are non-metallic and radiolucent, making diagnosis challenging and potentially delaying appropriate management. MRI plays a key role in identifying radiolucent foreign bodies, assessing dural integrity, and guiding surgical planning. We report a rare case of an intraspinal penetrating rubber bullet injury causing a thecal sac tear and neurological deficit, successfully managed with early surgical intervention. A 26-year-old male presented with lower-limb weakness and sensory loss following a close-range rubber bullet injury. Initial X-ray and CT imaging failed to identify the projectile. MRI revealed an intradural hypointense foreign body at L3–L4 with dural breach and CSF leak. The patient underwent L3–L4 laminectomy, microsurgical extraction of the rubber bullet, and dural repair using a synthetic graft and fibrin sealant. Postoperative neurological status and wound healing were monitored. Surgery revealed a 3.5 × 1.2 cm intradural rubber bullet fragment compressing the thecal sac and causing significant dural disruption. The projectile was removed without complications, and duraplasty was performed. The patient showed full neurological recovery (5/5 power) by postoperative day 7, with uneventful wound healing and no CSF leak and aligns with the previous cases reported in literature. Rubber bullet injuries to the spine can cause severe neurological damage and may be missed on routine radiographs and CT due to their radiolucent nature. MRI is essential for accurate detection and surgical planning. Early recognition and MRI-based surgical management can prevent permanent deficits in non metallic radiolucent projectiles like rubber or wooden objects causing spinal injuries which are equally harmful like metallic bullets commonly encountered