Management of civilian ballistic injuries to the spine: practice patterns and recovery outcomes at a level 1 trauma center.

BACKGROUND

The management of gunshot wounds to the spine remains controversial, given the limited number of cases, variability of injuries, and lack of standard treatment protocols. This study presents data from a major urban, academic, level 1 U.S. trauma center, with the aim of investigating the management pathways of spinal gunshot wounds.

METHODS

We performed a retrospective single-center study spanning from 2011-2023. Thirty-nine patients with gunshot wounds to the spine were identified.

RESULTS

Patients were predominantly male (92.3%) with a mean age of 25 years. Demographics included Black (78.4%), Hispanic (18.9%), and Caucasian (2.7%). American Spinal Injury Association Impairment Scale (AIS) scores on presentation were: 31.6% A, 0.0% B, 5.3% C, 18.4% D, 44.7% E. The primary location of the lodged bullet was the lumbar spine (45.5%), followed by thoracic (27.3%) and cervical (21.2%). Prophylactic antibiotics were used in 79.5%. Of the patients, 12.8% developed wound infections unrelated to the spinal column. Four patients underwent surgery (10.3%). The remaining five patients (12.8%) were managed without bracing. Outcomes upon discharges were: modified Rankin scale (mRS) of 0-2 (47.4%) or 3-4 (44.7%), AIS A (23.7%), C (7.9%), D (23.7%) and E (44.7%), with 44.1% sensation intact. Motor status from presentation to discharge was largely unchanged in 40.0% compared to worse or improved (10.0% each). Median follow-up was 2.1 months (0.9-11.6 months), with unchanged AIS scores. There was considerable variation within AIS category D.

CONCLUSIONS

Most patients were managed conservatively, with largely unchanged functional outcomes. Further studies with a larger sample size and standardized data collection may provide further insight to determine the efficacy of treatment options of gunshot wounds to the spine.