Treatment of Acute Penetrating Injuries of the Spine

Simpson, Richard K.; Venger, Benjamin H.; Narayan, Raj K.

doi:10.1097/00005373-198901000-00008

Cited by 78 publications

(61 citation statements)

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“…1,7,16,35,38 This finding, however, has not been supported by others. 12 Complications that have been reported include CSF leak, postoperative instability, neurological decline, epidural hematoma, meningitis, and local infection.…”

Section: Perioperative Complicationsmentioning

confidence: 62%

“…Although 2 papers were published in the post-Vietnam War era, their data collection occurred during the Vietnam War era and thus were excluded. 17,41 Metropolitan trauma centers included Philadelphia (2 reports 16,25 ), Houston (2 reports 35,38 ), Los Angeles (1 report 45 ), Shreveport (1 report 5 ), Chicago (1 report 9 ), and The Bronx (1 report 23 ). There were 694 patients collectively, the vast majority being male (639 patients).…”

Section: Civilian Literaturementioning

confidence: 99%

“…Four papers in which there was complete preoperative, postoperative, and nonoperative data, containing patients with both complete and incomplete neurological injury, strongly concluded that surgery was of no benefit. 16,25,35,38 …”

Section: Current Literaturementioning

confidence: 99%

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Can surgery improve neurological function in penetrating spinal injury? A review of the military and civilian literature and treatment recommendations for military neurosurgeons

Klimo

Ragel

Rosner

et al. 2010

FOC

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Neurosurg Focus 28 (5):E4, 20101 P atients with PSIs present very complex, multidisciplinary management challenges for military surgeons. Not only can the patient have immediate and delayed life-threatening damage to organs along the path of the projectile, the spinal column and possibly the neurological structures contained within can also, by definition, suffer injury, the severity of which depends on multiple factors. Spinal cord injury from spinal GSWs is more often a complete lesion with a decreased potential for neurological recovery than with closed trauma. 43There are a number of potential surgical indications, the most controversial of which is whether decompressive laminectomy has any effect on neurological recovery. Medical civilian and military literature is replete with opinions for and against the use of surgery.Although missile characteristics such as size, composition and design are important, the major determinant of the destructive ability of a projectile is velocity at impact and thus the kinetic energy imparted to the surrounding tissue.10 Energy is calculated based on mass and velocity as follows: energy = 1/2mv 2 . Therefore, velocity has a significantly greater effect on energy than projectile mass. Object. Penetrating spinal injury (PSI), although an infrequent injury in the civilian population, is not an infrequent injury in military conflicts. Throughout military history, the role of surgery in the treatment of PSI has been controversial. The US is currently involved in 2 military campaigns, the hallmark of both being the widespread use of various explosive devices. The authors reviewed the evidence for or against the use of decompressive laminectomy to treat PSI to provide a triservice (US Army, Navy, and Air Force) consensus and treatment recommendations for military neurosurgeons and spine surgeons.Methods. A US National Library of Medicine PubMed database search that identified all literature dealing with acute management of PSI from military conflicts and civilian urban trauma centers in the post-Vietnam War period was undertaken.Results. Nineteen retrospective case series (11 military and 8 civilian) met the study criteria. Eleven military articles covered a 20-year time span that included 782 patients who suffered either gunshot or blast-related projectile wounds. Four papers included sufficient data that analyzed the effectiveness of surgery compared with nonoperative management, 6 papers concluded that surgery was of no benefit, 2 papers indicated that surgery did have a role, and 3 papers made no comment. Eight civilian articles covered a 9-year time span that included 653 patients with spinal gunshot wounds. Two articles lacked any comparative data because of treatment bias. Two papers concluded that decompressive laminectomy had a beneficial role, 1 paper favored the removal of intracanal bullets between T-12 and L-4, and 5 papers indicated that surgery was of no benefit.Conclusions. Based on the authors' military and civilian PubMed literature search, most of the evidence s...

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Section: Perioperative Complicationsmentioning

confidence: 62%

Section: Civilian Literaturementioning

confidence: 99%

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Can surgery improve neurological function in penetrating spinal injury? A review of the military and civilian literature and treatment recommendations for military neurosurgeons

Klimo

Ragel

Rosner

et al. 2010

FOC

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“…Studies evaluating nonoperative management reported a weighted rate of neurologic recovery averaging 65.3% in patients with incomplete deficit and 12.7% in patients with complete deficit. Three studies demonstrated very poor improvement in neurological outcomes for patients with CGSWSCI who had a complete deficit compared with patients with an incomplete deficit irrespective of what treatment was given [28][29][30]. A few studies [4,7,14,32] reported a favorable surgical outcome for patients who demonstrated radiographic evidence of compression with a progressive neurological deficit.…”

Section: Resultsmentioning

confidence: 99%

Civilian Gunshot Injuries of the Spinal Cord: A Systematic Review of the Current Literature

Sidhu

Ghag

Prokuski

et al. 2013

Clinical Orthopaedics &Amp; Related Research

129

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Background The principles that guide management of spinal cord injury (SCI) derive from injury resulting from blunt trauma, not gunshot wounds. Civilian gunshot-induced spinal cord injury (CGSWSCI) is a common, potentially serious cause of neurological deficit; there is disagreement about whether the same approaches used for SCI caused by blunt-force trauma should apply to gunshot-induced SCI. Questions/purposes We reviewed the literature to answer the following questions regarding presentation and outcome of gunshot wound-induced SCI: (1) Are there differences in recovery prognosis between complete SCI and other patterns of SCI in CGSWSCI. (2) Does the use of steroids improve neurological recovery? (3) Does surgery to remove the bullet affect neurological recovery in CGSWSCI? (4) Does surgery result in an increased risk of complications of treatment? Methods We performed a systematic literature review of articles related to civilian gunshot injuries to the spine. Information relating to incidence, pattern of neurological injury, associated injuries, treatment, neurological outcome, and associated complications was extracted. Three independent reviewers assessed the strength of evidence present in the literature by examining quality, quantity, and consistency of results.

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“…Penetrating spinal injuries most commonly occur due to missile, sharp knifelike objects and rarely due to glass (4, 15,17,18,21). However, cases with intradural foreign bodies after penetrating injuries except missile injuries are very rare (5, 8, 9, 11,24).…”

Section: Introductionmentioning

confidence: 99%

Cervical intradural glass fragment: a rare cause of neuropathic pain

Akçakaya

Aras²,

Yörükoğlu³

et al. 2011

Turkish Neurosurgery

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Intradural foreign bodies after penetrating injuries are seen very rarely. Limited number of cases of glass fragments in the spinal canal were reported previously. Migration of foreign bodies and delayed onset of neurological symptoms due to foreign bodies were also reported. In this report a 33-year-old male patient was presented, who had penetration of glass fragments through oropharyngeal mucosa in to the spinal canal after crashing into a glass door. Glass fragment, which migrated through an unusual route, and reached cervical spinal intradural space, caused neuropathic pain with radicular symptoms, 21 years after the initial injury. This case report emphasize that after penetrating injuries of spine, foreign bodies may remain silent until the patient became symptomatic years after the initial injury and these foreign bodies may migrate to extreme distant and unexpected locations in the central nervous system. KeywoRds: Intradural foreign bodies, Migration, Glass, Neuropathic pain ÖZ Delici-kesici yaralanmalar sonrası intradural yabancı cisimler oldukça nadirdir. Omurilik kanalı içerisinde yabancı cisim olarak cam parçası görülmesi ve bunun yer değiştirerek geç dönemde semptomlara yol açması daha da nadirdir. Bu çalışmada, omurilik kanalı içerisinde yer değiştiren cam parçasına bağlı geç dönemde şikayetleri ortaya çıkan 33 yaşında bir erkek hasta sunulmuş; nadir görülmesi ve genel tecrübeye katkıda bulunmak amacıyla tartışılması amaçlanmıştır. Hastanın 21 yıl önce cam kapıya çarpma sonrası ağız mukozasına cam parçaları saplandığı öğrenilmiş ve bu parçaların servikal spinal intradural mesafeye ulaşarak hastada radiküler bulgularla birlikte nöropatik ağrıya sebep olduğu görülmüştür. Omuriliğin delici-kesici yaralanmalarında nadir de olsa yabancı cisimlerin omurilik kanalında kalabileceği ve bunların hem medüller hem de radiküler bulgulara yol açabileceği unutulmamalıdır. Orofarinks mukozasının delici-kesici yaralanmalarında da yabancı cisimlerin omurilik kanalına ulaşarak, erken dönemde veya yer değiştirme sonrası geç dönemde klinik bulgular ortaya çıkartabileceği gözden kaçırılmamalıdır.

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Treatment of Acute Penetrating Injuries of the Spine

Cited by 78 publications

References 0 publications

Can surgery improve neurological function in penetrating spinal injury? A review of the military and civilian literature and treatment recommendations for military neurosurgeons

Can surgery improve neurological function in penetrating spinal injury? A review of the military and civilian literature and treatment recommendations for military neurosurgeons

Civilian Gunshot Injuries of the Spinal Cord: A Systematic Review of the Current Literature

Cervical intradural glass fragment: a rare cause of neuropathic pain

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