Low-Velocity Gunshot Wounds to the Spine with an Associated Transperitoneal Injury

Lin, Sheldon S.; Vaccaro, Alexander R.; Reisch, Steven; Devine, Michael; Cotler, Jerome M.

doi:10.1097/00002517-199504000-00008

Cited by 45 publications

(39 citation statements)

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“…Complete deficit was reported to be more dependent on spinal injury level, violation of bone architecture by the bullet, and presence of a bullet in the canal. Based on data from 10 studies, CGSWSCI rate at the cervical level was 30% (315 of 1055), at the thoracic level was 49% (518 of 1055), and at the lumbosacral level was 21% (222 of 1055) [13,[17][18][19][20][21][22][23][24][25]. Of the cervical SCIs, two studies examining gunshot injuries to the cervical spine reported the rate of complete injury to be approximately 70% (46 of 66) [26,27].…”

Section: Resultsmentioning

confidence: 99%

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

Sidhu

Ghag

Prokuski

et al. 2013

Clinical Orthopaedics &Amp; Related Research

Self Cite

129

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Background The principles that guide management of spinal cord injury (SCI) derive from injury resulting from blunt trauma, not gunshot wounds. Civilian gunshot-induced spinal cord injury (CGSWSCI) is a common, potentially serious cause of neurological deficit; there is disagreement about whether the same approaches used for SCI caused by blunt-force trauma should apply to gunshot-induced SCI. Questions/purposes We reviewed the literature to answer the following questions regarding presentation and outcome of gunshot wound-induced SCI: (1) Are there differences in recovery prognosis between complete SCI and other patterns of SCI in CGSWSCI. (2) Does the use of steroids improve neurological recovery? (3) Does surgery to remove the bullet affect neurological recovery in CGSWSCI? (4) Does surgery result in an increased risk of complications of treatment? Methods We performed a systematic literature review of articles related to civilian gunshot injuries to the spine. Information relating to incidence, pattern of neurological injury, associated injuries, treatment, neurological outcome, and associated complications was extracted. Three independent reviewers assessed the strength of evidence present in the literature by examining quality, quantity, and consistency of results.

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Section: Resultsmentioning

confidence: 99%

“…Civilian gunshot wound-associated spinal cord injury (CGSWSCI) alone accounts for 13% to 17% of all cases of spinal trauma [1,6,9,10,21,25]. Many patients with a CGSWSCI require medical and surgical intervention.…”

Section: Introductionmentioning

confidence: 99%

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

Sidhu

Ghag

Prokuski

et al. 2013

Clinical Orthopaedics &Amp; Related Research

Self Cite

129

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“…13,43,46 A minimum of 3 days but more typically a 7-14-day course of broad-spectrum intravenous antibiotics with coverage of gram-positive, gram-negative, and anaerobic bacterial flora is effective at preventing most infections, including those in patients with transcolonic wounds. 7,27,33 There is no need to operate to remove bullet fragments to prevent lead or copper toxicity as this is an extremely rare complication even in the new era of IEDs. There is also no role for the administration of trauma-dose Solu-Medrol in these patients.…”

Section: Our Recommendations For Deployed Military Neurosurgeonsmentioning

confidence: 99%

Can surgery improve neurological function in penetrating spinal injury? A review of the military and civilian literature and treatment recommendations for military neurosurgeons

Klimo

Ragel

Rosner

et al. 2010

FOC

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Neurosurg Focus 28 (5):E4, 20101 P atients with PSIs present very complex, multidisciplinary management challenges for military surgeons. Not only can the patient have immediate and delayed life-threatening damage to organs along the path of the projectile, the spinal column and possibly the neurological structures contained within can also, by definition, suffer injury, the severity of which depends on multiple factors. Spinal cord injury from spinal GSWs is more often a complete lesion with a decreased potential for neurological recovery than with closed trauma. 43There are a number of potential surgical indications, the most controversial of which is whether decompressive laminectomy has any effect on neurological recovery. Medical civilian and military literature is replete with opinions for and against the use of surgery.Although missile characteristics such as size, composition and design are important, the major determinant of the destructive ability of a projectile is velocity at impact and thus the kinetic energy imparted to the surrounding tissue.10 Energy is calculated based on mass and velocity as follows: energy = 1/2mv 2 . Therefore, velocity has a significantly greater effect on energy than projectile mass. Object. Penetrating spinal injury (PSI), although an infrequent injury in the civilian population, is not an infrequent injury in military conflicts. Throughout military history, the role of surgery in the treatment of PSI has been controversial. The US is currently involved in 2 military campaigns, the hallmark of both being the widespread use of various explosive devices. The authors reviewed the evidence for or against the use of decompressive laminectomy to treat PSI to provide a triservice (US Army, Navy, and Air Force) consensus and treatment recommendations for military neurosurgeons and spine surgeons.Methods. A US National Library of Medicine PubMed database search that identified all literature dealing with acute management of PSI from military conflicts and civilian urban trauma centers in the post-Vietnam War period was undertaken.Results. Nineteen retrospective case series (11 military and 8 civilian) met the study criteria. Eleven military articles covered a 20-year time span that included 782 patients who suffered either gunshot or blast-related projectile wounds. Four papers included sufficient data that analyzed the effectiveness of surgery compared with nonoperative management, 6 papers concluded that surgery was of no benefit, 2 papers indicated that surgery did have a role, and 3 papers made no comment. Eight civilian articles covered a 9-year time span that included 653 patients with spinal gunshot wounds. Two articles lacked any comparative data because of treatment bias. Two papers concluded that decompressive laminectomy had a beneficial role, 1 paper favored the removal of intracanal bullets between T-12 and L-4, and 5 papers indicated that surgery was of no benefit.Conclusions. Based on the authors' military and civilian PubMed literature search, most of the evidence s...

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“…59 Lin et al treated 29 patients with only 48 hours of prophylactic antibiotics, and only two patients developed paraspinal infections in the form of psoas abscesses. 60 Kumar et al reported no spinal infection in their series of 13 patients with trans-colonic injuries who were treated with 7 days of prophylactic antibiotics. 61 Rabinowitz et al published their retrospective review of 51 patients with trans-visceral injuries in 2012.…”

Section: Antibiotics and Wound Managementmentioning

confidence: 96%

Civilian gunshot wounds of the spine: A literature review

Botha¹,

Booysen²,

Dunn³

2016

SA orthop. j.

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Low-Velocity Gunshot Wounds to the Spine with an Associated Transperitoneal Injury

Cited by 45 publications

References 0 publications

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

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

Can surgery improve neurological function in penetrating spinal injury? A review of the military and civilian literature and treatment recommendations for military neurosurgeons

Civilian gunshot wounds of the spine: A literature review

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