Penetrating Spinal Column Injuries (pSI): An Institutional Experience with 100 Consecutive Cases in an Urban Trauma Center

Gutierrez, Alexis; Su, YouRong Sophie; Vaughan, Kerry A.; Miranda, Stephen P.; Chen, H. Isaac; Petrov, Dmitriy; Malhotra, Neil R.; Schuster, James M.

doi:10.1016/j.wneu.2020.02.173

Cited by 9 publications

(5 citation statements)

References 30 publications

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“…5,[16][17][18][19][20][21][22][23] Studies were further excluded if they did not include patients with injuries to the lumbosacral spine or if it was not possible to calculate the number of lumbosacral spine patients who showed neurologic improvement in each group. 6,12,13,[24][25][26][27][28][29][30][31][32][33][34] Simpson et al was excluded from the study as it included the same population of patients included in Robertson and Simpson. 35,36 Overall 5 studies were included in quantitative synthesis that directly compared neurologic improvement following surgical and nonoperative management of patients who presented after gunshot wounds to the lumbosacral spine.…”

Section: Resultsmentioning

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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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: Resultsmentioning

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, several studies have demonstrated that non-nickel and non-steel based bullets are safe to undergo MRI. 13 - 15 Venous lead levels are routinely drawn on GSW patients in order to obtain baseline values. If spinal instability is present, bracing is offered or surgical intervention consisting of instrumentation and fusion with removal of bullet fragment if encountered.…”

Section: Resultsmentioning

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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“…It is well known, that gunshot wounds to the spine have a high rate of complications ( Sidhu et al, 2013 ; Nwosu et al, 2017 ). The last decade published case series, described an overall rate of complications between 36 and 45 % ( Villarreal-et al, 2022 ; McCunniff et al, 2017 ; Escamilla et al, 2018 ; Nwosu et al, 2017 ; Bumpass et al, 2015 ; Beaty et al, 2014 ; Abbas et al, 2019 ; Gutierrez et al, 2020 ; Eftekhary et al, 2016 ; Sajid et al, 2020 ; Joseph, 2017 ; Ge et al, 2022 ). Bumpass et in a retrospective study of 159 patients, had 45 % of patients who experienced at least 1 documented complication from their gunshot injury ( Bumpass et al, 2015 ).…”

Section: Discussionmentioning

confidence: 99%

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

Ricciardi,

Cabrera,

Martínez

et al. 2024

Brain and Spine

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Penetrating Spinal Column Injuries (pSI): An Institutional Experience with 100 Consecutive Cases in an Urban Trauma Center

Cited by 9 publications

References 30 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

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

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