Civilian Gunshot Wound to the Spine: 87 Cases

Abstract

Introduction Penetrating spinal cord injury (SCI) by gunshot is relatively common in Brazil, and the literature available is scarce. This study aims to report the experience of a level I trauma center, exploring epidemiological data, clinical features, treatment, and outcomes of victims of gunshot wound to the spine. Material and Methods A retrospective study was performed and included all victims of gunshot wound to the spine at João XXIII Hospital from April 2011 to March 2014 (36-month period). The epidemiological profile, topography of the injury, neurological status, treatment, and in-hospital morbidity and mortality are reported. Statistical analysis was performed on Epi Info 7.0 with Fisher exact test. Correlation with the current literature was conducted. Results A total of 1,088 patients were admitted with blunt and penetrating spinal injury in the 36 months evaluated. A total of 87 cases were gunshot wounds (8% of the 1,088 cases). A majority of the patients were men (93.1%) and young (76.1% are under 30 years). Topographically, 48% affected the cervical spine, followed by 32% in the thoracic spine. The motor status had a dichotomous presentation, with complete neurological deficit (ASIA A, 58.6%) and no neurological deficit (ASIA E, 27.6%). Incomplete neurological deficits represented a small number of cases. The vertebral instability, defined as the presence of acute or delayed deformity, was unusual (three cases, 3.4%). Almost 50% ( n = 44) of the patients had isolated spinal trauma and the remaining presented with associated traumas. Thoracic trauma was the most prevalent, followed by abdominal and facial injury. Only 10 patients (11.5%) required surgical treatment: laminectomy with bullet removal in 7 cases and instrumented fixation in the remaining 3. Infection was present in five cases: four postoperative infections and one in a patient with nonoperative management. Surgical treatment was associated with a 50-fold increase risk of infection ( p = 0.0004). CSF fistula was observed in only one case after surgical treatment and because of the rarity of the event, a statistical analysis could not be performed. Overall mortality was 14.9% (13 patients) and was more common in patients with cervical lesions (10 patients). Associated trauma was present in 70% of the patients who died, but did not acquire statistical significance ( p = 0.1) with mortality risk. Conclusion Gunshot wound to the spine is common in our population, affecting especially young men, associated with neurological deficit in two-thirds of the patients. Instability is a rare event in these patients (3.4%) and surgical treatment was associated with a significant risk of infection.