Anterior lumbar interbody fusion for degenerative disc disease induced by retained gunshot projectile: A case report.

Background: Degenerative disc disease (DDD) may emerge years after spinal trauma, particularly when ballistic fragments remain lodged within the disc space. Case Description: A 31-year-old male presented with a 1-year history of progressive low back pain and bilateral sciatica, 12 years after a conservatively managed lumbar gunshot injury with no initial neurological deficits. Imaging demonstrated a retained projectile within the L5-S1 disc space, associated with disc height loss, retrolisthesis, and Modic type 3 endplate changes. Anterior lumbar interbody fusion (ALIF) at L5-S1 was performed, permitting direct bullet removal and placement of an interbody cage. Early postoperative radiographs confirmed appropriate implant positioning with restoration of disc height and sagittal alignment, while clinical follow-up over 6 months documented sustained symptomatic improvement. Conclusion: In anatomically suitable scenarios, ALIF may represent a safe and effective option for the removal of anteriorly retained bullet fragments while addressing L5-S1 DDD.