Gunshot wounds to the spine

Area of Science:

• Traumatology
• Neurosurgery
• Orthopedic Surgery

Background:

• Low velocity gunshot injuries (GSI) represent 13% of urban spinal injuries in the USA.
• GSI are the second leading cause of spinal cord injuries.
• Initial assessment must include vascular, visceral, and neurological status.

Purpose of the Study:

• To review the management of spinal injuries caused by low velocity gunshots.
• To outline optimal diagnostic and therapeutic strategies for GSI.

Main Methods:

• Review of clinical evaluation protocols for GSI.
• Analysis of imaging modalities including plain radiographs and computed tomography.
• Evaluation of treatment strategies such as steroids, prophylactic antibiotics, and surgical intervention.

Main Results:

• Early imaging with CT and radiographs is essential for bone injury assessment.
• Steroid use is controversial; consider in neurological deficits within 8 hours.
• Prophylactic antibiotics are indicated mainly for visceral perforation.
• Early surgical exploration is recommended for vascular/visceral injuries.
• Spinal decompression does not influence neurological recovery.
• Most GSI spine fractures are stable; instability often results from over-decompression.
• Retained fragments are rarely problematic; lead toxicity is a potential complication.

Conclusions:

• Management of GSI requires a multidisciplinary approach focusing on initial assessment and appropriate imaging.
• Surgical intervention should target associated injuries, not spinal decompression for neurological recovery.
• Careful consideration of prophylactic measures and potential long-term complications like lead toxicity is necessary.