An Update on Civilian Spinal Gunshot Wounds

Bumpass, David B.; Buchowski, Jacob M.; Park, Andrew; Gray, Benjamin L.; Agarwal, Rashmi; Baty, Jack; Zebala, Lukas P.; Riew, K. Daniel; Santiago, Paul; Ray, Wilson Z.; Wright, Neill M.

doi:10.1097/brs.0000000000000797

Cited by 34 publications

(33 citation statements)

References 37 publications

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“…In our study, roughly two-thirds of patients had neurologic involvement without any patients showing spinal instability. This data is consistent with previous work by Bumpass et al who showed a high rate of neurologic compromise despite low rates of biomechanical instability with CSGSW [ 19 ]. Prior studies suggest that in CSGSW, neural and spinal cord damage are generally due to direct impact, thermal energy, or blast effect ( Figure 4 ) rather than compression or tension as seen in blunt force trauma [ 1 , 20 ].…”

Section: Discussionsupporting

confidence: 93%

Stability of the Subaxial Spine after Penetrating Trauma: Do Classification Systems Apply?

Staggers

Niemeier

Neway

et al. 2018

Advances in Orthopedics

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Objective Blunt spinal trauma classification systems are well established and provide reliable treatment algorithms. To date, stability of the spine after civilian gunshot wounds (CGSWS) is poorly understood. Herein, we investigate the validity of trauma classification systems including the Thoracolumbar Injury Classification and Severity Score (TLICS), Subaxial Cervical Spine Injury Classification and Severity Score (SLIC), and Denis' three-column model when applied to spinal penetrating trauma from gunshots, while secondarily evaluating stability of these injuries. Methods Gunshot injuries to the spine were identified from an institutional database from ICD-nine codes. Trauma scorings systems were applied using traditional criteria. Neurologic compromise and spinal stability were evaluated using follow-up clinic notes and radiographs. Results Thirty-one patients with CSGSW were evaluated. There was an equal distribution of injuries amongst the spinal levels and spinal columns. Twenty patients had neurological deficits at presentation. Eight patient had a TLICS score >4. Three patients had a SLIC score >4. One patient had surgical treatment. Nonoperative treatment did not lead to spinal instability or adverse outcomes in any cases. The posterior column had a high correlation with neurologic compromise, though not statistically significant (p=.118). Conclusions The TLICS, SLIC, and three-column classification systems cannot be applied to CSGSW to quantify injury severity, predict outcomes, or guide treatment decision-making. Despite significant neurologic injuries and disruption of multiple spinal columns, CSGSW do not appear to result in unstable injuries requiring operative intervention. Further research is needed to identify the rare spinal gunshot injury that would benefit from immediate surgical intervention.

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Section: Discussionsupporting

confidence: 93%

Stability of the Subaxial Spine after Penetrating Trauma: Do Classification Systems Apply?

Staggers

Niemeier

Neway

et al. 2018

Advances in Orthopedics

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“…Thoracic region is the most commonly affected area[ 17 ] with most risk of complete injury[ 4 ] for civilian gunshot wounds. In an epidemiological investigation involving combat casualties and including explosions and gunshot injury, Schoenfeld et al .…”

Section: Discussionmentioning

confidence: 99%

“…In a recent series involving civilians, Bumpass et al . [ 4 ] concluded the surgical indication as post-gunshot spinal infections and persistent CSF leaks. They pointed that injury caused by a small-caliber bullet to the spine infrequently destabilizes the spine, even if all the three columns are impacted.…”

Section: Discussionmentioning

confidence: 99%

Firearm bullet settling into the lumbar spinal canal without causing neurological deficit: A report of two cases

et al. 2016

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Background:Uncertainty still exists regarding the treatment of the patients presenting with gunshot wounds to the spine. Neurological insults, cerebrospinal fluid fistula, infection, lead or copper toxicity, migration of bullets, and spinal instability are included among the common challenging issues.Case Description:An 18-year-old woman was admitted with low back pain following a gunshot injury five days ago. She was neurologically intact. Radiological examinations showed that a bullet was settled in L4-5 disc space. The bullet was removed with a unilateral L4-5 partial hemilaminectomy and discectomy from the left side. The second case was of a 29-year-old man admitted with radiating leg pain on the right side following a gunshot injury from his left side of lower back four months ago. He had only positive straight leg raising test. Radiological studies showed two bullets, one was in the psoas muscle on the left side and the other was in spinal canal that had caused a burst fracture of the L5 vertebra. Following L5 laminectomy and bilateral L5-S1 facetectomy, the bullet was removed from the spinal canal and L5-S1 transpedicular posterior stabilization was performed. The postoperative period of both patients was unremarkable.Conclusion:Bullet settling into the lumbar spinal canal without causing neurological deficit may require surgical intervention. Removal of bullets provided not only pain relief in both the cases but also prevented future complications such as migration of the bullets, plumbism, and neuropathic pain and instability.

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“…In contrast, the civilian literature favors nonsurgical management unless there is evidence of incomplete injury to the spinal cord with progressive neurological deterioration and persistent CSF fistula, migration of bullet within the spinal canal is present. [ 45 ]…”

Section: Role Of Surgerymentioning

confidence: 99%

“…Indications for surgery in his study were spinal infection and persistent CSF leaks. [ 45 ] Yashon et al . also has similar experience in his study of 65 patients of civilian GSW.…”

Section: Role Of Surgerymentioning

confidence: 99%

Gunshot wound causing complete spinal cord injury without mechanical violation of spinal axis: Case report with review of literature

Patil

Jaiswal

Gupta

2015

J Craniovert Jun Spine

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Penetrating spine injury (PSI) forms the third most common cause of spine injury, only next to road traffic accidents and fall. Gunshot wound (GSW) forms the major bulk of PSI. Due to easy availability of firearms and antisocial behavior, GSW which were predominant in military population is now increasingly seen in civilized society. Here, we present a detail case review of unique case of civilian GSW indirectly causing complete spinal cord injury due to shock wave generated by the bullet, along with its systematic management.

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An Update on Civilian Spinal Gunshot Wounds

Abstract: 3.

Cited by 34 publications

References 37 publications

Stability of the Subaxial Spine after Penetrating Trauma: Do Classification Systems Apply?

Stability of the Subaxial Spine after Penetrating Trauma: Do Classification Systems Apply?

Firearm bullet settling into the lumbar spinal canal without causing neurological deficit: A report of two cases

Gunshot wound causing complete spinal cord injury without mechanical violation of spinal axis: Case report with review of literature

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