Shotgun Injuries of the Spine: Neurosurgical Management of Five Cases

Abstract

The role of neurosurgical intervention in penetrating spinal injury has not been clearly established. Functional outcome has not been shown to be influenced by operation. In fact, neurosurgical intervention has been shown to potentially increase the risk of serious complications. This paper examines a unique subset of patients with penetrating spinal injury-those secondary to shotguns. An analysis of five such cases and a review of the limited literature on the subject suggests that neurosurgical intervention is of limited value in such injuries and that initial management should focus primarily upon non-neurological injuries.

Surgical management of transcervical gunshot injury presented with CSF leak and progressive left upper extremity paresis: A case report and literature review

“…Although improvement in neurological outcome following laminectomy and intradural exploration as early treatment for penetrating spinal injury has not been clearly documented [12], some evidence recommends the initial surgical management in the cases of neurological de cits [4,9]. In our case, upper limb weakness was markedly improved just post-op and reached normal a few days later.…”

“…It seems that cord compression of the pellet was the main mechanism of neurological de cit in our patient. However, some more important mechanisms like axonal injury and cord contusion could lead to severe damage to the spinal cord following gunshot injuries [12]. There were a few reports related to the safe bullet's trajectory through the cervical spine (neck region) without any signi cant damages happening to the nervous system [13,14].…”

The military medical management of missile injury to the spine: A review of the literature and proposal of guidelines

“…Early assessment of the neurological status is deemed vital and should be carried out within 24 hours of the injury, after resuscitation, as the neurological and autonomic status has considerable implications for prognosis; assessment prior to resuscitation may give spurious results and delay treatment for life threatening injuries (5,7,22,31,38).…”

Civilian gunshot wounds of the spine: A literature review

“…The majority of studies published regarding civilian gunshot wounds are from the 1980s and 1990s. [12][13][14][15][16][17][18][19][20][21][22][23][24] Recent literature is mostly restricted to military gunshot injuries, which is more of the high velocity/energy type of injuries.…”