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

Abstract

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.

Predicting early complications in patients with spinal gunshot wounds: A multicenter study

“…Antibiotic therapy for 48–72 h with broad-spectrum antibiotics should be immediately initiated in all cases ( Bono and Heary, 2004 ; Jakoi et al, 2015 ; de Barros et al, 2014 ; Gjolaj and Eismont, 2015 ; Escamilla et al, 2018 ; Quigley and Place, 2006 ). The definitive treatment of spinal injury depends on multiple variables, and the amount of evidence to support surgical treatment remains unclear ( Sidhu et al, 2013 ; Escamilla et al, 2018 ; Klimo et al, 2010 ; Platt et al, 2022 ). Surgical indications are: spinal mechanical instability; incomplete and/or progression over time of neurologic impairment; the presence of bullet fragments or any identifiable compressive cause in the vertebral canal; infection; the presence of persistent dural leaks; and metal toxicity ( Bono and Heary, 2004 ; Jakoi et al, 2015 ; de Barros et al, 2014 ; McCunniff et al, 2017 ; Gjolaj and Eismont, 2015 ; Escamilla et al, 2018 ).…”

Recovery of volitional movement with epidural stimulation after “complete” spinal cord injury due to gunshot: A case report and literature review

“…[2,4,5,8] eSCS improves autonomic function and restores volitional movement in some SCI patients. [3,5,7] We report a 25-year-old pSCI patient who, following a GSW resulting in paraplegia, sustained marked recovery of function following eSCS…”

“…[ 1 , 7 ] Meta-analyses indicate no difference in recovery between operatively versus conservatively-managed pSCI patients; few in either group show meaningful recovery. [ 2 , 4 , 5 , 8 ] eSCS improves autonomic function and restores volitional movement in some SCI patients. [ 3 , 5 , 7 ] We report a 25-year-old pSCI patient who, following a GSW resulting in paraplegia, sustained marked recovery of function following eSCS placement.…”

“…[ 2 , 4 , 5 , 8 ] eSCS improves autonomic function and restores volitional movement in some SCI patients. [ 3 , 5 , 7 ] We report a 25-year-old pSCI patient who, following a GSW resulting in paraplegia, sustained marked recovery of function following eSCS placement. We identified four other patients in the literature discussing placement of eSCS for penetrating spinal GSW [ Table 2 ], PRISMA flow diagram is shown in [ Figure 4 ].…”