Concept of Gunshot Wound Spine

Abstract

Gunshot wound (GSW) to the spine which was earlier common in the military population is now being increasingly noted in civilians due to easy availability of firearms of low velocity either licensed or illegal combined with an increased rate of violence in the society. Contributing to 13% to 17% of all spinal injuries, the management of complex injury to the spine produced by a GSW remains controversial. Surgery for spinal cord injuries resulting from low velocity GSWs is reserved for patients with progressive neurologic deterioration, persistent cerebrospinal fluid fistulae, and sometimes for incomplete spinal cord injuries. Surgery may also be indicated to relieve active neural compression from a bullet, bone, intervertebral disk, or a hematoma within the spinal canal. Spinal instability rarely results from a civilian GSW. Cauda equina injuries from low velocity GSWs have a better overall outcome after surgery. In general, the decision to perform surgery should be made on consideration of multiple patient factors that can vary over a period of time. Although there have been plenty of individual case reports regarding GSW to the spine, a thorough review of unique mechanical and biological factors that affect the final outcome has been lacking. We review the key concepts of pathogenesis and management of GSW to the spine and propose an algorithm to guide decision making in such cases.

Central cord syndrome from blast injury after gunshot wound to the spine: a case report and a review of the literature

“…The nearer the firearm is to the target, the more damage it causes also associated to tearing and burning from gunpowder. 7 In our patient, only a fractured C5 spinous process was observed with no evidence of spinal stenosis, instability or intracanal fragments. Although an MRI was not performed, the CT scan showed sufficient evidence to guide management.…”

“…A trend was noted toward surgical management of lumbar or cauda equina injuries and nonsurgical/ observation of complete injuries. 7,14,17,18 CONCLUSION CCS is a common presentation in patients with spinal cord injury, although not commonly seen in patients who suffered GSW to the spine. Some suggested algorithms exist regarding the management of these patients, but still cases should be individualized depending on the specific nature of their presentation.…”

“…14 (b) Algorithm for decision to perform surgery in gunshot wound spine. 7 of intracanal bullet fragments show varying opinions in the literature reviewed. A trend was noted toward surgical management of lumbar or cauda equina injuries and nonsurgical/ observation of complete injuries.…”

“…14 Spinal instability can be present in any abnormal angulation or translation and in cases where the bullet traverses the pedicle or the facet. 7,14,17 Progressive neurological deficit, cerebrospinal fluid leak and evidence of lead toxicity are also complications in which surgical intervention is strongly recommended. Level of lesion (cervical, thoracic and lumbar), severity of injury, or the presence Figure 2.…”

“…Tetanus and broad-spectrum antibiotic prophylaxis should be considered initially at least in the first 24 h. Bullet extraction has not proven to decrease the risk of septic complications and may be associated to other complications related to surgery. 7,14 Surgical management Several algorithms have been proposed to aid in the decision of performing a surgical intervention in patients with GSW to the spine (Figure 2). It appears to be a consensus that spinal instability is an absolute indication for surgery, regardless of the severity of injury (complete or incomplete).…”