Gunshot injuries in the spine

• Published in: Spinal cord Vol. 52; no. 7; pp. 504 - 510
• Main Authors: de Barros Filho, T E P, Cristante, A F, Marcon, R M, Ono, A, Bilhar, R
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.07.2014; Nature Publishing Group
• Subjects: 692/699/375/1824; 692/699/578; 692/700/565; Anatomy; Biomedical and Life Sciences; Biomedicine; Human Physiology; Humans; Neurochemistry; Neuropsychology; Neurosciences; review; Spinal Cord Injuries - diagnosis; Spinal Cord Injuries - epidemiology; Spinal Cord Injuries - etiology; Spinal Cord Injuries - therapy; Wounds, Gunshot - complications; Wounds, Gunshot - diagnosis; Wounds, Gunshot - epidemiology; Wounds, Gunshot - therapy
• ISSN: 1362-4393; 1476-5624
• DOI: 10.1038/sc.2014.56

Study design: Review article. Objectives: To review the literature regarding treatment approaches in cases of gunshot wounds (GSWs) affecting the spine. Setting: Brazil. Methods: Narrative review of medical literature. Results: GSWs are an increasing cause of morbidity and mortality. Most patients with spinal GSW have complete neurological deficit. The injury is more common in young men and is frequently immobilizing. The initial approach should follow advanced trauma life support, and broad-spectrum antibiotic therapy should be initiated immediately, especially in patients with perforation of the gastrointestinal tract. The indications for surgery in spinal GSW are deterioration of the neurologic condition in a patient with incomplete neurological deficit, the presence of liquor fistula, spinal instability, intoxication by the metal from the bullet or risk of bullet migration. Conclusion: Surgical treatment is associated with a higher complication rate than conservative treatment. Therefore, the surgeon must know the treatment limitations and recognize patients who would truly benefit from surgery.