Gunshot injury to spine: An institutional experience of management and complications from a developing country

Abstract

Purpose Gunshot wounds are the second leading cause of spinal cord injuries. Surgical intervention for gunshot injury to the spine carries a high rate of complications. There is a scarcity of data on civilian gunshot injuries to the spine in Pakistan. Approximately 60 cases over the last 10 years have been recoded, with unusual presentation and neurological recovery. Thus it is imperative to fill this gap in data, by reviewing cases of civilian gunshot injuries to spine presenting at a tertiary care hospital (Aga Khan University Hospital, Karachi). Methods This is a retrospective cohort study. Patients of all ages who presented to the emergency department of Aga Khan University Hospital, with gunshot injuries to spine between January 2005 and December 2016 were included in the study. Data were collected on neurological status (American Spinal Injury Association score was used for the initial and follow-up neurological assessment), extent of cord transection, motor and sensory deficits. The patients were further grouped into those with cord transection, and those with fractures of the bony spine but an intact spinal cord. These patients were then followed and the outcomes were recorded. Results A total of 40 patients were identified. The mean ± SD of patients age was (30.9 ± 9.5) years. Of the 40 patients with gunshot wounds, 31 had the medical imaging performed at the facility, and hence they were included in this categorization. The remaining 9 patients were excluded from this additional grouping. Thirteen patients were managed surgically and 27 patients underwent the conservative management. The mean ± SD of follow-up was (8.7 ± 7.2) months. In our study, the thoracic spine was the most commonly injured region in gunshot injuries. Of the 31 patients with medical imaging performed at our institute, 17 (54.8%) had cord transection, of whom 8 (47%) ultimately developed paraplegia. Conclusion The prognosis of gunshot injuries to the spine can be varied depending on whether the spinal cord is intact or transected. This will help healthcare providers to plan the further management of the patient and counsel them accordingly.

Comments on “Gunshot injury to spine: An institutional experience of management and complications from a developing country”‐‐‐‐‐The need for an interdisciplinary spinal cord injury rehabilitation for improving outcomes in patients with gunshot injury to spine

“…We have read the paper “ Gunshot injury to spine: an institutional experience of management and complications from a developing country ’’ by Sajid et al. 1 with interest. They have described the mechanism of injury, presentation, complications and outcomes of gunshot wound-related spinal cord injury (SCI) in Pakistan: a low middle-income country (LMIC).…”

“… 5 Pressure ulcers in SCI can be prevented by proper positioning, frequent change in posture, regular skin check, employing pressure ulcer prevention strategies and early mobilization. 1 , 6 …”

“…Depending upon the level and severity of injury, the options may include clean intermittent catheterization, creeds maneuver and follow-up by urodynamic studies in these patients. 1 , 7 There is a need for early mobilization and integration of multidisciplinary team to prevent SCI associated complications. Neurogenic bladder management reduces the incidence of urinary tract infection in these patients, which is the leading cause of bladder calculi and upper urinary tract complications such as pyelonephritis, renal scaring and renal failure.…”

“…Sajid et al. 1 have also highlighted the financial burden of managing gunshot related SCI in the context of a LMIC like Pakistan. Most patients with SCI are young males and the sole bread earner for the family.…”

“…Authors have reported a follow-up of approximately 9 months. 1 This is a short-term follow-up considering that SCI is often a life-long and permanent disability, which should be followed for long to identify, prevent and manage long term complications adequately.…”