Spinal Gunshot Wounds: Pattern and Associated Lesions in Civilians

• Main Authors: Jorge Arturo Cabrera Escamilla, Jorge Álvaro González Ross, José Manuel Pérez Atanasio, Gustavo Casas Martínez, Arelhi González Cisneros, Jose Jimenez Avila
• Format: Article
• Language: English
• Published: Korean Spine Society 2018-08-01
• Series: Asian Spine Journal
• Subjects: Bullet wound; Spinal injuries; Civilian; Soft tissue injuries; Spinal cord injuries
• Online Access: http://www.asianspinejournal.org/upload/pdf/asj-2018-12-4-648.pdf

Study Design Retrospective, descriptive case series study. Purpose To investigate the frequency, bone pattern, and associated lesions to the spine of gunshot wounds. Overview of Literature Gunshot wounds are penetrating in nature and are caused by a bullet or projectile. These are becoming more common and are associated with significant sequelae, requiring long and costly multidisciplinary treatment. Associated spinal cord injuries (SCIs) in the civilian population represent 13%–17% of all spinal traumas. Spinal gunshot wounds are commonly thought to be stable; however, there is potential acute and chronic spinal instability if the bullet passes transversely, fracturing either both pedicles or both facet joints. Methods We obtained data from the clinical files of patients with spinal gunshot wounds treated by spine surgeons. We performed a statistical analysis to obtain the pattern and frequency of the injuries. Results We included 54 patients (48 men [89%] and six women [11%]). Eight patterns of spinal gunshot wounds were identified; 61% (33 patients) had complete SCI. The thoracic spine was most frequently affected, with 88% of patients having SCI; 75%, hemopneumothorax; 28%, pulmonary lesions; and 16%, hepatic lesions. The presence of pedicle fractures had an odds ratio of 3.64 for SCI. Conclusions The two main bone patterns are the vertebral body and posterior arch with pedicle fractures as modifiers, given that they are at a high risk for SCI. The spinal pattern and associated lesions were related to the bullet’s path, with the vertebral body having the highest frequency of associated lesions. Vertebral body burst fracture was the main indication for instrumentation.