A natural history of penetrating ballistic spinal column injury: a single-center continuous case series

The aim of this study was to characterize patient demographics, injury characteristics, clinical management, and inpatient hospital course of victims of gunshot wounds (GSWs) to the spine to describe a "natural history" of disease following this injury.

A retrospective analysis was conducted of patients with GSWs to the spine at a level I trauma center in a major urban center from January 2016 to December 2021. Data on demographics, injury grades/characteristics, and treatment course were analyzed using descriptive and comparative statistics.

Of 237 identified cases, patients were predominantly male (210, 88.6%) with a mean age of 26.3 ± 9 years. The most common injury site was the thoracic spine (36.7%), followed by lumbar (30.0%). Most patients (126, 53.2%) had a neurological deficit. A significant number of patients had either bullet fragments (34, 14.3%) or bone fragments (31, 13.1%) in the canal on imaging. Nonoperative management was the primary treatment strategy, with only 2 patients requiring decompressive spinal surgery; no patient underwent fusion. Conventional mean arterial pressure (MAP) goals were maintained in 60 patients (25.3%) for a mean of 5.04 ± 1.86 days, and 4 patients (1.7%) received prophylactic antibiotics for spinal injury. Patients with neurological deficits were more likely to have a neurosurgical consultation and were significantly more likely to have MAP goals as part of their management (p < 0.001). The mean hospital length of stay was 11.5 ± 11.4 days with a mean follow-up time of 7.85 ± 14.74 months, suggesting a minimum postinjury survival period. Most patients were discharged home (141, 59.5%) with a mean modified Rankin Scale score of 2.6 ± 1.8.

This study represents the largest continuous series of GSWs to the spine in contemporary literature, suggesting a natural history of survivorship and disability in this patient population and characterizing common treatment paradigms at a major urban trauma center.