Gunshot Injuries to the Spine

Gjolaj, Joseph P.; Eismont, Frank J.

doi:10.2106/jbjs.rvw.o.00011

Cited by 7 publications

(17 citation statements)

References 44 publications

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“…Several previous studies and reviews have recommended broad spectrum antibiotics for patients who sustain gunshot wounds to the spine for at least 48 hours with consideration of longer durations with bowel, specifically colonic, injury. 2,[9][10][11][12]41,42 Only one included study specified the number of complications that occurred in both the surgical and non-operative group, therefore again there was insufficient data to make a meaningful conclusion regarding the risks of complications following surgical and non-operative management of gunshot wounds to the lumbosacral spine. Bumpass et al found, in a study of patients who presented with gunshot wounds to the spine (including cervical and thoracic), that patients who underwent operative management had a significantly increased risk of suffering a complication compared to patients treated non-operatively.…”

Section: Discussionmentioning

confidence: 99%

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Gunshot Wounds to the Lumbosacral Spine: Systematic Review and Meta-Analysis

Platt

Dafrawy

Lee

et al. 2021

Global Spine Journal

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Study Design: Systematic review and meta-analysis. Objectives: Indications for surgical decompression of gunshot wounds to the lumbosacral spine are controversial and based on limited data. Methods: A systematic review of literature was conducted to identify studies that directly compare neurologic outcomes following operative and non-operative management of gunshot wounds to the lumbosacral spine. Studies were evaluated for degree of neurologic improvement, complications, and antibiotic usage. An odds ratio and 95% confidence interval were calculated for dichotomous outcomes which were then pooled by random-effects model meta-analysis. Results: Five studies were included that met inclusion criteria. The total rate of neurologic improvement was 72.3% following surgical intervention and 61.7% following non-operative intervention. A random-effects model meta-analysis was carried out which failed to show a statistically significant difference in the rate of neurologic improvement between surgical and non-operative intervention (OR 1.07; 95% CI 0.45, 2.53; P = 0.88). In civilian only studies, a random-effects model meta-analysis failed to show a statistically significant difference in the rate of neurologic improvement between surgical and non-operative intervention (OR 0.75; 95% CI 0.21, 2.72; P = 0.66). Meta-analysis further failed to show a statistically significant difference in the rate of neurologic improvement between patients with either complete (OR 4.13; 95% CI 0.55, 30.80; P = 0.17) or incomplete (OR 0.38; 95% CI 0.10, 1.52; P = 0.17) neurologic injuries who underwent surgical and non-operative intervention. There were no significant differences in the number of infections and other complications between patients who underwent surgical and non-operative intervention. Conclusions: There were no statistically significant differences in the rate of neurologic improvement between those who underwent surgical or non-operative intervention. Further research is necessary to determine if surgical intervention for gunshot wounds to the lumbosacral spine, including in the case of retained bullet within the spinal canal, is efficacious.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Gunshot Wounds to the Lumbosacral Spine: Systematic Review and Meta-Analysis

Platt

Dafrawy

Lee

et al. 2021

Global Spine Journal

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“…However, in the setting of a retained bullet in the canal, there is a role to remove the bullet in order to decrease the risk of elevated lead level and plumbism overtime. 32,33 (Figure 3). Literature on the mid to long-term clinical outcomes of patients with spinal GSW is sparse.…”

Section: Discussionmentioning

confidence: 99%

“… 5 , 30 , 31 However, in the setting of a retained bullet in the canal, there is a role to remove the bullet in order to decrease the risk of elevated lead level and plumbism overtime. 32 , 33 ( Figure 3 ).…”

Section: Discussionmentioning

confidence: 99%

Civilian Gun Shot Wounds Associated With Spinal Injuries

Jubril

Mesfin

2021

Global Spine Journal

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Study Design: Retrospective Objective: To evaluate functional outcomes and characteristics associated with gunshot wound (GSW) to the spine. Methods: Patients with GSW to the spine managed at a Level 1 Trauma Center from January 2003 to December 2017 were enrolled. Patient demographics, diagnoses, level of injury, American Spinal Injury Association (ASIA) score, ambulatory status at follow-up, bowel and bladder function, clinical improvement, and mortality were evaluated. Clinical improvement was defined as a progression in ambulatory status category at latest follow up. Results: 51 patients with GSW of the spine were identified. 48 (94.1%) were male and 3 (5.9%) were female, with a mean age of 27 years-old (range 15-56). 38 (74.5%) were Caucasian, 7 (13.7%) were African American, 1 (2.0%) Asian-American, and 5 (9.8%) were Other/Unknown. 46 (90.2%) patients had GSW related spinal fractures and 44 (86.3%) had neurological deficits. Among patients with neurologic deficits, 5 (9.8%) had Cauda Equina Syndrome, 1 (2%) had Brown-Sequard Syndrome, and 38 (74.5%) spinal cord injuries: ASIA A 26 (68.4%); ASIA B 3 (7.9%); ASIA C 7 (18.4%); ASIA D 2 (5.3%). At mean follow-up time of 4.2 years (SD 3.9), 27 (52.9%) patients were wheelchair bound, 11 (21.6%) were ambulating with assistance, and 13 (25.5%) had normal ambulation. ASIA grade (A or B) was significantly, P < 0.00001, associated with being wheelchair bound and having neurogenic bowel or bladder at follow-up. Conclusions: Most spinal GSW patients (70.6%) did not have any clinical improvement in ambulatory status and most injuries were ASIA A.

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“…Cervical spine injuries are more likely to be unstable, and careful evaluation of imaging with or without upright views is helpful to guide decision-making 95 . This may be related to the relative size of the bullet to the vertebral body 95,104 . Cervical spine injuries with progressive kyphosis can be associated with late deterioration of neurologic status and should be considered for operative fusion 95 (Fig.…”

Section: Spine and Spinal Cord Injuriesmentioning

confidence: 99%

Firearm-Related Injuries—Wound Management, Stabilization, and Associated Injuries

et al. 2023

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Gun violence–related and firearm-related injuries are a public health crisis with increasing rates, particularly among younger demographics, in the United States despite a decline in incidence worldwide.There exists limited high-quality evidence to guide the management of firearm-related orthopaedic injuries.Associated injuries (i.e., neurological and vascular) are common in ballistic injuries to the extremity.Where indicated, low-energy orthopaedic injuries can be managed successfully with standard fixation and management strategies with similar complications to closed fractures.

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Gunshot Injuries to the Spine

Cited by 7 publications

References 44 publications

Gunshot Wounds to the Lumbosacral Spine: Systematic Review and Meta-Analysis

Gunshot Wounds to the Lumbosacral Spine: Systematic Review and Meta-Analysis

Civilian Gun Shot Wounds Associated With Spinal Injuries

Firearm-Related Injuries—Wound Management, Stabilization, and Associated Injuries

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