Gunshot Spinal Injury: Factors Determining Treatment and Outcome

Spinal gunshot injuries are devastating injuries with significant morbidity and mortality. The purpose of this study was to compare the varied neurologic presentations and radiologic findings with their outcomes after treatment. We applied the Thoracolumbar Injury Classification and Severity Scale and Subaxial Cervical Spine Injury Classification to see whether the management of gunshot patients was performed according to the severity of the scores.

Between 2011 and 2014, 150 consecutive patients with spinal gunshot injury were admitted and treated at Liaquat National Hospital and Medical College, Karachi. We assessed patients neurologically by using the American Spinal Injury Association (ASIA) Scale. The morphologic parameters of injury were measured with the Thoracolumbar Injury Classification and Severity Scale and Subaxial Cervical Spine Injury Classification. The patients were either conservatively or surgically treated, and the ASIA Scale was applied at 1, 12, and 24 months.

In the study, the ASIA Scale was applied on admission, in which 39% were ASIA A, 9.8% B, 15.6% C, 12.3% D, and 28% E. ASIA A was most commonly seen in the thoracic region. Sixty-two percent of the patients were treated conservatively and 38% surgically. After we applied the thoracolumbar and cervical injury severity scores, 36 patients scored under the nonsurgical criteria, and 79 patients scored in the surgical criteria. Overall improvement was seen in 31% of the patients in whom thoracic region showed greatest progress.

Patients with gunshot injury should be considered for surgery when there is potential for improvement, if there is persistent cord compression, or if there is deteriorating or incomplete neurology. Lumbar gunshot injury has a better outcome compared with thoracic followed by cervical injury.