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Indian Journal of Neurotrauma 2018; 15(02/03): 051-056
DOI: 10.1055/s-0039-1677669
Original Article
Thieme Medical and Scientific Publishers Private Ltd.

Analysis of Surgical Outcome in Patients with Firearm Injury to Spine

Dibya Jyoti Mahakul
1   Department of Neurosurgery, AIIMS, New Delhi, India
,
Ramesh Doddamani
1   Department of Neurosurgery, AIIMS, New Delhi, India
,
Rajesh Meena
1   Department of Neurosurgery, AIIMS, New Delhi, India
,
Deepak Agrawal
1   Department of Neurosurgery, AIIMS, New Delhi, India
› Author Affiliations
Further Information

Publication History

Received: 16 July 2018

Accepted after revision: 29 August 2018

Publication Date:
23 July 2019 (online)

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Abstract

Aim of Study To see whether surgical intervention in gunshot injuries to the spine leads to recovery in neurologic status.

Methods It is a retrospective study conducted at the Jai Prakash Narayan Apex Trauma Centre (JPNATC), All India Institutes of Medical Sciences (AIIMS), New Delhi, where case records of 20 patients with gunshot injury to the spine, admitted between January 2013 to March 2018, were analyzed.

Result Out of 20 patients, 17 underwent surgical intervention. Entry wound was most common on the back, with the thoracic vertebrae being the most common segment involved. Nine patients had complete spinal cord injury (SCI) at the time of presentation and seven of them underwent surgery. However, only one of these patients showed neurologic improvement at follow-up. Seven patients with canal compromise underwent surgery, and only two of them showed improvement in neurologic status at follow-up. Early surgery was done in 8 out of 16 patients. All 16 patients underwent decompressive procedure, and 3 underwent additional stabilization procedure. Bullet was removed in nine cases. Intraoperative blood loss was minimal in 9 cases, and dural breach was noticed in 14 cases. At follow-up, 56.25% patients showed improvement in neurologic status.

Conclusion Surgical intervention, timing of surgery, amount of intraoperative blood loss, and dural breach had no significant impact on the overall surgical outcome. Neurologic status at the time of presentation is the single most important factor that determines the ultimate outcome. Indication and type of surgical intervention is still an ambiguous topic. Owing to lack of conclusive evidence, we believe that there is role for surgery when it is done with an intention to restore the neurologic function.

Keywords

gunshot injury to spine - gunshot wound - spinal injury - complete spinal cord injury - penetrating spinal injury
 

  • References

  • 1 Farmer JC, Vaccaro AR, Balderston RA, Albert TJ, Cotler J. The changing nature of admissions to a spinal cord injury center: violence on the rise. J Spinal Disord 1998; 11 (05) 400-403
    PubMedGoogle Scholar
  • 2 Miller CA. Penetrating wounds of the spine. In: Wilkins RH, Rengachary SS. eds. Neurosurgery. Vol. 2. San Francisco, CA: McGraw-Hill; 1985: 1746-1748
    Google Scholar
  • 3 DeMuth Jr WE. Bullet velocity as applied to military rifle wounding capacity. J Trauma 1969; 9 (01) 27-38
    CrossrefPubMedGoogle Scholar
  • 4 Yoshida GM, Garland D, Waters RL. Gunshot wounds to the spine. Orthop Clin North Am 1995; 26 (01) 109-116
    CrossrefPubMedGoogle Scholar
  • 5 Velmahos GC, Degiannis E, Hart K, Souter I, Saadia R. Changing profiles in spinal cord injuries and risk factors influencing recovery after penetrating injuries. J Trauma 1995; 38 (03) 334-337
    CrossrefPubMedGoogle Scholar
  • 6 Schneider RC, Webster JE, Lofstrom JE. A follow-up report of spinal cord injuries in a group of World War II patients. J Neurosurg 1949; 6 (02) 118-126
    CrossrefPubMedGoogle Scholar
  • 7 Simpson Jr RK, Venger BH, Narayan RK. Treatment of acute penetrating injuries of the spine: a retrospective analysis. J Trauma 1989; 29 (01) 42-46
    PubMedGoogle Scholar
  • 8 Koizumi M, Ueda Y, Iida J. et al. Upper thoracic spinal cord injury without vertebral bony lesion: a report of two cases. Spine 2002; 27 (21) E467-E470
    CrossrefPubMedGoogle Scholar
  • 9 Meyer PR, Apple DF, Bohlman HH, Ferguson RL, Stauffer ES. Symposiusm: management of fractures of the thoracolumbar spine. Contemp Orthop 1988; 16: 57-86
    PubMedGoogle Scholar
  • 10 Aarabi B, Alibaii E, Taghipur M, Kamgarpur A. Comparative study of functional recovery for surgically explored and conservatively managed spinal cord missile injuries. Neurosurgery 1996; 39 (06) 1133-1140
    CrossrefPubMedGoogle Scholar
  • 11 Hammoud MA, Haddad FS, Moufarrij NA. Spinal cord missile injuries during the Lebanese civil war. Surg Neurol 1995; 43 (05) 432-437 discussion 437–442
    CrossrefPubMedGoogle Scholar
  • 12 Cybulski GR, Stone JL, Kant R. Outcome of laminectomy for civilian gunshot injuries of the terminal spinal cord and cauda equina: review of 88 cases. Neurosurgery 1989; 24 (03) 392-397
    CrossrefPubMedGoogle Scholar
  • 13 Benzel EC, Hadden TA, Coleman JE. Civilian gunshot wounds to the spinal cord and cauda equina. Neurosurgery 1987; 20 (02) 281-285
    CrossrefPubMedGoogle Scholar
  • 14 Waters RL, Adkins RH. The effects of removal of bullet fragments retained in the spinal canal. A collaborative study by the National Spinal Cord Injury Model Systems. Spine 1991; 16 (08) 934-939
    CrossrefPubMedGoogle Scholar