Introduction: Gunshot injuries to the spine are unfortunately common in Pakistan and neighboring countries because of political turmoil. They lead to severe economic problem for the patients family and the community. Our study was to look at patients presenting with spinal gunshot injury and outcome secondary to intervention or conservative treatment. Unfortunately because of geographical location of Pakistan, gunshots are common. They are a major problem from economic perspective as well. Our objective was to evaluate different patterns of Spinal gunshot injuries, their outcomes and to find if the spinal stability scales are good predictors of the management and outcomes.
Methods: We present a prospective study of 150 patients from January 2011 till December 2014, admitted through A&E, at our center. 17 had associated cranial, 30 had chest and 31 had abdominal injuries. The patients were evaluated on admission clinically, radiologically, and using ASIA scale. Their clinical assessment and radiological findings were used to apply the TLICS or the SLICS depending on the site. Then patients were reevaluated after 1 month and 12 months of injury using ASIA scale and the results were compared.
Results: Out of 150 patients with gunshot, 31 percent were cervical, 39 percent were thoracic, 24 percent were lumbar and only 6 percent were sacral. Sixty percent of the patients were treated conservatively while 40 percent were treated surgically in which 40 percent required decompression and 30 percent required stabilization. Thoracolumbar injuries had the best outcome followed by cervical injuries. Young patients presenting early with incomplete injuries had a better outcome.
Conclusions: Progressive neurology or incomplete injury with CSF leak or unstable spine, were indications for surgery. Incomplete injuries with neurological deterioration showed benefit, with early surgery. Patients with complete injury, and associated injuries were mainly conservatively managed and recovery was minimal.
Patient Care: My research enlightens on the subject of when to operate on a spinal gunshot patient and in our experience what has been a better management plan for different patterns of spinal gunshot injury.
Learning Objectives: Spinal Gunshot injury management and treatment.
The prognosis of different patterns of spinal gunshot injuries.