Application of Current Spine Classification Systems to Civilian Gunshot Wounds that were Designed for Blunt Force Trauma

Abstract

Introduction Spine classification systems have been used for years to create a universal language for describing injuries to the spinal column, as well as guiding clinical management. These classification systems were developed for use with blunt force trauma, but it is unknown whether they can be used for injuries to the spine caused by a gunshot wound. Purpose This study aims to investigate whether classification systems such as the Thoracolumbar Injury Classification and Severity Score (TLICS) and the Denis Classification can be applied to spinal injuries as a result of gunshot wounds in addition to blunt force trauma. Patients and Methods A retrospective analysis of the trauma patient database registry from the University of Alabama at Birmingham was undertaken for gunshot and spine fracture ICD-9 codes. A total of 32 patients had sustained spinal injuries caused by a gunshot wound. Each patient was evaluated for location of spine fracture and vertebral structures involved, neurological involvement, stability, treatment, and follow-up status. We then applied the TLICS and Denis classification system to evaluate ease of application and usefulness. Results A total of 32 patients were evaluated and found to have gunshot wounds that resulted in injury to the spinal vertebra, vertebral ligaments, intervertebral disk, or the spinal cord. The location of injuries ranged from C1 to L5 and varied in the type of fracture. Injuries that had neurological involvement correlated with injury to the posterior column (as per the Denis Classification). There was little correlation with the anterior or middle columns with neurological involvement. Of 32 patients, only 1 had received surgical treatment. This patient had a disruption of all three columns, but similarly, there were nine other patients whose injuries involved all three columns, and yet they did not receive surgery. Conclusion TLICS was very difficult to apply to gunshot wounds and the Denis system provided no prognostic information despite a relative ease of use. It is our opinion that a new classification system needs to be designed to specifically include the injury patterns seen from a gunshot wound. Also, there was a little evidence that abstaining from a surgical treatment would cause any significant short- or long-term problems for the patient. Involvement of the posterior column correlated with neurological involvement but does not implicate the need for surgery or debridement.