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  • Civilian Gunshot Injuries to the Spine: An Update on Surgical Indications, Long-Term Outcomes, and Complications

    Final Number:

    David Bumpass MD; Jacob Buchowski MD; Andrew Park MD; Benjamin L Gray MD; Lukas Zebala MD; Neill Marshall Wright MD

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    Subject Category:

    Meeting: Congress of Neurological Surgeons 2012 Annual Meeting

    Introduction: Civilian gunshot wounds (GSWs) to the spine are commonly treated at urban trauma centers. No major series of these injuries in the civilian population has been described in more than 15 years. We present the second-largest series of civilian spine GSWs in the literature.

    Methods: Patients were retrospectively identified using an ICD9 code search of hospital records from 2003-11 at a single urban Level 1 trauma center. We identified 159 consecutive pts w/ both spine fractures and injury by firearm

    Results: There were 147 male and 12 female pts, w/ mean age 28 yrs (range 16-65). Mean f/u was 13 mo, w/ 35 having >2 yr f/u. Mean hospital LOS was 13 days; 5 pts died during initial hospitalization. The C-spine was involved in 46 cases, the T-spine in 53 cases, the L-spine in 50 cases, and the sacrum in 10 cases. The vertebral body and transverse processes were most-commonly fractured (30% and 31% of cases). Ten pts were treated operatively; indications were epidural abscess (1 pt presented at 21 days and the other at 50 days post-GSW), persistent CSF leak (1 pt), instability (6 pts), and decompression of an incomplete spinal injury (4 pts). Seventy-nine pts were initially ASIA grade E. Twenty pts w/ initial deficits experienced improvement of at least one ASIA grade (25% of pts w/ initial deficits); one of these was operatively treated. Four improved pts were initially ASIA A, 4 were ASIA B, 8 were ASIA C, and 4 were ASIA D.

    Conclusions: Of 159 GSWs, 149 were treated non-operatively and 10 merited surgical intervention. Neurologic improvement of at least one ASIA grade was seen in 25% of patients with cord injury. In general non-op treatment is indicated, but surgical intervention should be considered in pts w/ incomplete lesions or deteriorating neurologic status.

    Patient Care: By reviewing a large civilian experience with gunshots to the spine, our research illustrates the fractures commonly seen, the indications for surgical intervention, and the treatment algorithms needed in these patients.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) describe the common fractures seen with gunshots to the spine; 2) describe the indications for surgical intervention with gunshots to the spine; 3) identify treatment algorithms for gunshots to the spine.


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