An Update on Civilian Spinal Gunshot Wounds. Issue 7 (1st April 2015)

• Record Type: Journal Article
• Authors: Bumpass, David B.; Buchowski, Jacob M.; Park, Andrew; Gray, Benjamin L.; Agarwal, Rashmi; Baty, Jack; Zebala, Lukas P.; Riew, K. Daniel; Santiago, Paul; Ray, Wilson Z.; Wright, Neill M.
• Is Part Of: Spine. Volume 40:Issue 7(2015)
• Publication Date: 2015-04-01
• Subjects: Spine -- Abnormalities -- Periodicals; Spine -- Diseases -- Periodicals; Spine -- Surgery -- Periodicals; 616.73005
• DOI: 10.1097/BRS.0000000000000797
• Languages: English
• ISSNs: 0362-2436

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Study Design.</title> <p>Retrospective analysis of inpatient and outpatient data from a single academic trauma center.</p> </sec> <sec> <title>Objective.</title> <p>To test the effectiveness of a conservative treatment algorithm for civilian spinal gunshot wounds (CSGSWs) by comprehensively evaluating neurological status and recovery, fracture type, concomitant injuries, indications for surgery, and complications.</p> </sec> <sec> <title>Summary of Background Data.</title> <p>Few large studies exist to guide treatment of CSGSWs, and none have been published in nearly 20 years.</p> </sec> <sec> <title>Methods.</title> <p>A search of <italic>International Classification of Diseases, Ninth Revision</italic> (<italic>ICD-9</italic>) codes was performed for all hospital patients treated from 2003 to 2011 by either neurosurgery or orthopedic surgery to identify 159 consecutive patients who sustained CSGSWs. Mean follow-up was 13.6 months. American Spinal Injury Association grading was used to assess neurological injury.</p> </sec> <sec> <title>Results.</title> <p>Fifty percent of patients had neurological deficits from CSGSW. Complete spinal injury was the most common injury grade; thoracic injuries had the most risk of complete injury (<italic>P</italic> < 0.001). Nearly 80% of patients had concomitant injuries to other organs. Operative treatment was more likely in patients with severe neurological injuries (<italic>P</italic> = 0.008) but was not associated with improved neurological outcomes (<italic>P</italic> = 1.00). Nonoperative treatment did not lead to any cases of late spinal instability or neurological deterioration. Overall, 31% of patients had an improvement of at least 1 American Spinal Injury Association grade by final follow-up. Nearly half of patients experienced at least 1 GSW-related complication; risk of complications was associated with neurological injury grade (<italic>P</italic> < 0.001) and operative treatment (<italic>P</italic> = 0.04).</p> </sec> <sec> <title>Conclusion.</title> <p>The vast majority of CSGSWs should be managed nonoperatively, regardless of neurological grade or number of spinal columns injured. Indications for surgery include spinal infection and persistent cerebrospinal fluid leaks.</p> <p> <bold>Level of Evidence:</bold> 3</p> </sec> </abstract>