Gunshot Wounds to the Spinal Cord*

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

“…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.…”

The association of rehabilitation and war

“…42 As the result of this approach, of the 2500 casualties with paraplegia sustained by US forces in WWII 70% returned to their homes able to drive a car, and 60% were successful in obtaining employment. 3 The experience of rehabilitating spinal cord injuries during the Yom Kippur War in 1973 and the Lebanon War of 1982 supported the previously expressed view 43 that there was no significant difference between patients who undergo laminectomy and those treated conservatively. 44 Since the energy from high-velocity bullets or other projectiles may cause significant spinal cord dysfunction as a result of distant penetration with subsequent shock waves, surgery is not indicated in war 45 and the sole indication for surgical intervention appears to be progressive neurological deficit.…”

Long term follow up of spinal cord injury caused by penetrating missiles

“…The initial treatment, conservative ver sus surgical, of the spinal column has no direct effect on the subsequent rehabilita tion programme. [6][7][8] The late appearance of common medical complications in the SeIP, and the number of urological and plastic surgical treatments after the initial hospitalisation probably reflect the fact that all high level SCIP who are supported by the Ministry of Defence have constant 24 hour attendants.9,10 The increased number of SelP who have hae morrhoids probably reflects the inappropri ate seating on cushions and wheelchairs some years ago, and the prolonged period of sitting for defecation. Erysipelas probably results from wearing inappropriate footware (sandals without socks), inappropriate foot care, and the improper cutting of toenails.…”