Treatment of asymptomatic gunshot injuries to the spine

Gunshot wounds to the spine and spinal canal are usually associated with significant neurologic loss. When this occurs, treatment is usually supportive, the predominant indication for surgical intervention being progression of the deficit. If the deficit does not progress, but a spinal block can be demonstrated to persist beyond the acute injury period, surgical decompression may also be indicated. When no neurologic deficit is present, the optimum approach is less clear. Complications such as infection or persistent cerebrospinal fluid (CSF) leak may necessitate surgical repair in asymptomatic patients, as well as those with neurologic loss. The presence of copper in the spinal canal is also considered by some to be an indication for surgical intervention in both groups.