256. Surgical intervention is associated with improvements in the ASIA impairment scale in gunshot induced spinal injuries of the thoracic and lumbar spine

Abstract

<h3>BACKGROUND CONTEXT</h3> Spinal injuries are relatively common injuries that have a lasting impact on patients and are a significant cause of disability. Gunshot induced spinal injuries (GSIs) are the third most common cause of spinal injury and are increasing in proportion. Despite the severity and frequency of these injuries, there remains a lack of conclusive evidence regarding the optimal management of patients with GSIs. <h3>PURPOSE</h3> We aimed to better understand the impact of surgical intervention in patients who sustained gunshot induced spinal injuries. <h3>STUDY DESIGN/SETTING</h3> Retrospective comparative study. <h3>PATIENT SAMPLE</h3> Patients in the National Spinal Cord Injury Statistical Center (NSCISC) database with GSIs and complete one-year follow-up information. (n = 961) <h3>OUTCOME MEASURES</h3> The primary outcome measure was defined as improvement in ASIA Impairment Scale from the time of presentation. <h3>METHODS</h3> Patient demographics, clinical information, and outcome data were extracted from the NSCISC database. Surgical intervention was defined as any procedure involving a laminectomy, neural canal restoration, open reduction, spinal fusion, or internal fixation of the spine. Functional assessments included the American Spinal Injury Association (ASIA) Impairment scale. Bivariate analysis as well as multivariate analysis was performed. <h3>RESULTS</h3> A total of 961 patients with GSI and one-year follow-up were identified from 1975-2016. The majority of patients were Black/African American (55.6%), male (89.7%), and aged 15-29 (73.8%). Of those who underwent surgical intervention, 34.2% had an improvement in their ASIA Impairment Scale at one year as compared to 20.6% of those treated non-operatively. Overall, surgery was associated with 2.0 [95% CI 1.4 - 2.8] times greater likelihood of ASIA Impairment Scale improvement at one year. Specifically, benefit was seen in thoracic (OR 2.5 [95% CI 1.4-4.6]) and lumbar injuries (OR 1.7 [95% CI 1.1-3.1]), but not cervical injuries. At 5-year follow-up, surgery was associated with 6.2 [95% CI 1.4-16.0] times greater likelihood of improvement in the ASIA Impairment Scale. <h3>CONCLUSIONS</h3> While the decision to undergo surgery should be individualized, in our large review of GSIs, surgical intervention was associated with a greater likelihood of neurologic recovery. Specifically, patients with thoracic and lumbar GSI have a 2.5- and 1.7-times, respectively, greater likelihood of improvement in their ASIA Impairment Scale one year after injury if they underwent surgical intervention. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.