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Indian Journal of Neurotrauma 2012; 09(02): 99-111
DOI: 10.1016/j.ijnt.2012.11.012
Original Article
Thieme Medical and Scientific Publishers Private Ltd.

Missile injuries of spine and spinal cord in civilian Kashmir – Analysis and outcome evaluated by new Modified SKIMS-Functional Scales

Abdul Rashid Bhat
a   Additional Professor, Department of Neurosurgery, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, Kashmir, India
,
Mohammed Afzal Wani
b   Head & Professor of Neurosurgery, SKIMS, Srinagar, Kashmir, India   Email: waniafzal@rediffmail.com
e   Tel.: +91 9419000313 (mobile).
,
Altaf Rehman Kirmani
c   Professor, Department of Neurosurgery, SKIMS, Srinagar, Kashmir, India   Email: kirmanialtaf@rediffmail.com
f   Tel.: +91 9419006376 (mobile).
,
Shafiq Alam
d   Senior Resident, Department of Neurosurgery, SKIMS, Srinagar, Kashmir, India
g   Tel.: +91 9419081343 (mobile).
,
Tariq Raina
d   Senior Resident, Department of Neurosurgery, SKIMS, Srinagar, Kashmir, India
,
Sajad Arif
d   Senior Resident, Department of Neurosurgery, SKIMS, Srinagar, Kashmir, India
h   Tel.: +91 9419081385 (mobile).
,
Altaf Ramzan
a   Additional Professor, Department of Neurosurgery, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, Kashmir, India
i   Tel.: +91 9419081142 (mobile).
,
Masood A. Lahawal
d   Senior Resident, Department of Neurosurgery, SKIMS, Srinagar, Kashmir, India
› Author Affiliations
Subject Editor:
Further Information

Publication History

03 September 2012

02 November 2012

Publication Date:
06 April 2017 (online)

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Abstract

Aims

Since the emergence of missile injuries of spinal cord is a major management-challenge due to its vulnerable vascularity, narrowly-packed neurons and tracts, associated injuries caused by kinetic-energy of missiles, we sought analysis and evaluation of missile injuries of spinal cord with the application of indigenously devised Modified SKIMS-Functional Classification, SKIMS-injury types and Modified SKIMS-Functional Outcome scale.

Methods

The study was conducted retrospectively in Neurosurgery, SKIMS, single tertiary unit in Jammu and Kashmir State of India, over a period of 22 years (January 1989–December 2010). The missile injuries of spine and spinal cord were managed under a standard medical and uniform protocol. The civilians, injured due to firing of metallic-bullets, pellets, tear-gas shells etc, received within 24 h of injury. Temporary spinal immobilization, resuscitation (ABC-Guidelines), methyl prednisolone infusion and clinico-imaging evaluation were carried out. Triaging was done by indigenous Modified SKIMS-Functional Classification and SKIMS-injury types, while results assessed by Modified SKIMS-Functional Outcome scale.

Results

Among 334 spinal missile injuries, penetrating injuries were 55.08%, SKIMS-injury type-a (musculo-skeletal neural) 61.07% and metallic-bullets were commonest (69.76%) missiles causing 44.63% dorsal injuries. The Modified SKIMS-Functional Classification rapidly triaged and prognosticated spinal missile injuries. The CT-myelography was study of choice. The intrathecal and intramedullary missile migration, “Second-Flight of Bullet” occurred in 1.49%. About 80.83% underwent surgery. The new indigenous Trans-axillary Approach was applied in 3.33% D2-3 spinal-fixation. Meningitis and CSF leak were common. However Modified SKIMS-Functional Outcome scale showed that 47.30% (158/334) of all spinal missile injuries improved neurological grade, 14.97% (50/334) died, most of these in group A Modified SKIMS-Functional Classification, and 37.72% (126/334) patients had no improvement by the end of 6 months. Among all groups, group C was most salvageable.

Conclusion

The prognosis of missile injuries of spine stays grim with only 7.18% (24/334) patients improved to Modified SKIMS-Functional Outcome group D (good-recovery). The multi-factorial criteria, not alone complete/incomplete injury-concept, ought to be framed in favour of or against surgery. The Modified SKIMS-Functional Classification, SKIMS-injury types and Modified SKIMS-Functional Outcome scale helped in rapid triaging and prognosticating the spinal missile injuries.

Keywords

Spinal missile injuries - Modified SKIMS-Functional Classification - Modified SKIMS-Functional Outcome scale
 

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