The researchers queried recent studies on MEDLINE for case reports of spinal gunshot injuries and how they were managed. Here are eight things to know based on the report:
1. Gunshot injuries are now the third most common cause of spinal injury.
2. The firearms used in gunshot injuries to the spine are either high- or low-energy, depending on the projectile’s initial velocity.
3. The neural mechanical spinal damage is variable based on the:
• Direct impact
• Concussion waves
• Tissue cavitation
• Thermal energy
4. Additional factors to consider when managing patients with a gunshot injury to the spine include:
• Neurologic function and change over time
• Spinal stability
• Missile tract through the body
• Concomitant injury
5. Progressive neurologic changes, spinal instability, persistent cerebrospinal fluid leak and infections are typically indications for surgery.
6. The best outcomes are associated with gunshot injuries impacting T12. Caudal typically is associated with better outcomes than cranial to T12.
7. Incomplete or worsening neurologic injury typically indicate removing the missile fragments in the spinal canal.
8. Treating spinal gunshot injuries requires a multidisciplinary approach to maintain or restore spinal ability and neurologic function while minimizing complications.
“Concomitant injuries and complications following spinal gunshot injuries can present immediate and ongoing challenges to the medical, surgical and rehabilitative care of the patient,” concluded the study authors.
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