Radiographic Predictors of Spinal Column Instability After Gunshot Wounds: A Pragmatic Score

Background Firearm injuries to the spinal column remain a major public health concern in the United States and present a challenge in assessing spinal stability. Currently, no scoring system exists to evaluate ballistic injuries to the spinal column. We propose the Ballistic Assessment in Spine Trauma (BLAST) score to differentiate stable from unstable ballistic spine fractures for the purpose of operative stabilization. Methods Over approximately 14 years, the neurosurgical service at the University of Mississippi Medical Center evaluated 353 gunshot wounds (GSWs) to the spine. Patients with radiographic injury to the spinal column were included and evaluated using the BLAST score in this retrospective chart review study. Results Our results indicate that a score of 6 or greater correlates with operative management. Overall, the BLAST score performed comparably to the accuracy reported in validation studies of the Subaxial Cervical Spine Injury Classification System (SLICS), Thoracolumbar Injury Classification and Severity Scale (TLICS), and Spinal Instability Neoplastic Scale (SINS). The BLAST score achieved receiver operating characteristic (ROC) area under the curve (AUC) values of 0.965 and 0.812 for cervical and thoracolumbar injuries, respectively. The scoring system also demonstrated kappa statistics of 0.39 and 0.40 and intraclass correlation coefficients (ICCs) of 0.82 and 0.79 for the cervical and thoracolumbar spine, respectively. Conclusion The BLAST score offers an efficient, accurate, and pragmatic composite scoring system that can differentiate stable from unstable spinal injuries caused by GSWs.