American Spinal Injury Association (ASIA) Impairment Scale Motor Grade Outcomes Among Patients With Ballistic Neurologic Injuries Managed Expectantly: A 13-Year Single Institution Retrospective Review and Narrative Review of the Literature.

Background  Gunshot wounds (GSW) are increasingly prevalent in the United States. There is a paucity of data and guidelines governing surgical versus non-surgical management of neurologic GSW. One challenge lies in characterizing and stratifying the natural history of GSW to the nervous system (i.e., neurologic injuries) with respect to outcomes. Our group hypothesized that nonsurgical management would show promise and that rates of recovery would differ based on the injured area. Methods  We reviewed ballistic nervous system injuries involving the spine and extremities over a 13-year period at an urban level 1 trauma center. We classified neurologic injuries by localization and motor grade using the American Spinal Injury Association (ASIA) grading system. We then defined the "ASIA shift" (i.e., the change from one motor grade to another) for each injury population to determine outcomes in ballistic injuries managed expectantly. Results  Cervical spinal cord injuries (SCI), cauda equina injuries, and upper and lower extremity peripheral nerve injuries saw statistically significant improvement from non-antigravity to antigravity motor function while the L1 and conus medullaris injuries did not. Thoracic SCI had a higher rate of poor-grade injuries than other categories and saw the lowest rate of improvement. Cauda equina injuries saw significant improvement even when the injury implicated the spinal canal. Conclusion  Our retrospective cohort study contributes to characterizing the natural history of GSW to the nervous system with respect to motor outcomes. Our data suggests a favorable course for select GSW-associated SCI and cauda equina injury patients managed without intervention.