Firearm Injuries in the Spine. Effective Strategy for Diagnosis and Treatment

Abstract

The incidence of gunshot wounds to the spine on civilians has increased alarmingly and accounts for 13% to 17% of all traumatic spinal injuries, placing them in third place among the most frequent mechanisms. However, the management of these injuries is still controversial. At present there is little information on the management of these lesions, conservative treatment (non-surgical) being recommended in most publications. Based on the current literature, we propose a procedural protocol aimed at improving the quickness of management, as well as the prognosis of the patient. For this purpose, once the patient is hemodynamically stabilized, the following should be assessed: 1) Stability; 2) Compressive extrusion; 3) Accommodation or not in the discal space, and 4) Contact with CSF. These points are relevant to make the best decision.

Spinal Gunshot Wounds: Pattern and Associated Lesions in Civilians

“…More than half of patients with non-fatal gunshot wounds require hospitalization [ 7 ]. Associated spinal cord injuries (SCIs) in the civilian population represent 13%–17% of all spinal traumas and are among the most devastating sequelae [ 1 , 4 , 7 , 8 ].…”

“…After evaluating the airway, breathing, and circulation, neurological examination can be performed. Physical examination has a sensitivity of 100% and a specificity of 87.5% for SCIs and critical lesions requiring stabilization [ 5 , 8 ].…”

“…Therefore, careful radiographic evaluation is necessary. If the stability is questionable, flexion and extension X-rays or computed tomography (CT) scans might be necessary [ 3 , 8 ]. Fractures of the vertebral body and of posterior elements can be quickly evaluated with a CT scan [ 5 , 7 , 9 ].…”

Recuperación neurológica y motora en lesión raquimedular por proyectil de arma de fuego: reporte de caso

“…Una lesión completa se define ante la ausencia de funciones motoras o sensitivas por debajo de la lesión anatómica. La mayoría de las heridas por arma de fuego en columna provocan lesiones medulares completas, hasta en 62%, 6,7 representando un reto para la toma de decisiones sobre el manejo de esta patología.…”