Current treatment of gunshot wounds to the spine

The incidence of spinal cord injury from gunshot wounds in penetrating trauma continues to increase with the violent nature of society. This particularly is true in urban areas, as is found with other violent crime. Either the direct path of the bullet or the concussive effects cause injury to the spine and spinal column. Thorough patient evaluation and appropriate radiographic studies will provide the keys to treatment of these patients. Criteria are given for treatment related to neurologic findings and progressive neurologic evaluation. Infection related to missiles penetrating through the alimentary tract and then lodging in the spine is a relatively rare complication and appropriate standards for debridement and fragment removal are discussed. Principles of treatment in all missile injuries to the spine evolve around spine stability, aggressive rehabilitation, and preservation of neurologic function.