Spinal cord missile injuries during the Lebanese civil war

Spinal cord injuries due to penetrating wounds are not uncommon. The management of these injuries remains controversial especially with regard to the effect of laminectomy on the neurological outcome.

Between 1980 and 1989, 64 patients injured by bullets and shell fragments to the spinal cord were reviewed. There were 58 males and 6 females: 24 injuries (37.5%) involved the cervical spine, 37 (57.8%) the dorsal spine, and 3 (4.7%) the lumbar spine. One group (group I) consisted of 47 patients (73.4%) who had immediate and complete sensorimotor loss of function. Another group (group II) contained 13 patients (20.3%) who presented with incomplete and non-progressive spinal cord deficit. One patient (1.6%) (group III) had progressive spinal cord deficit. Three patients (4.7%) (group IV) had injuries to the cauda equina.

The results were analyzed using a chi-squared test when possible. In group I, 20 patients (42.5%) underwent laminectomy with no recovery, and 27 (57.5%) were treated conservatively, with 1 patient (3.7%) achieving marked improvement (p > 0.05). In group II, 3 patients (23.1%) underwent laminectomy with the 3 (100%) improved, and 10 patients (76.9%) were treated conservatively, with 8 (80%) recovering (p > 0.05).

Our data in groups I and II agree with previously published literature that shows no significant advantage of performing laminectomies following penetrating spinal cord injuries. Moreover, group I patients had a poor prognosis whether laminectomy was done or not, and group II patients had a good prognosis whether laminectomy was done or not.