Abstract
Review article. To review the literature regarding treatment approaches in cases of gunshot wounds (GSWs) affecting the spine. Brazil. Narrative review of medical literature. GSWs are an increasing cause of morbidity and mortality. Most patients with spinal GSW have complete neurological deficit. The injury is more common in young men and is frequently immobilizing. The initial approach should follow advanced trauma life support, and broad-spectrum antibiotic therapy should be initiated immediately, especially in patients with perforation of the gastrointestinal tract. The indications for surgery in spinal GSW are deterioration of the neurologic condition in a patient with incomplete neurological deficit, the presence of liquor fistula, spinal instability, intoxication by the metal from the bullet or risk of bullet migration. Surgical treatment is associated with a higher complication rate than conservative treatment. Therefore, the surgeon must know the treatment limitations and recognize patients who would truly benefit from surgery.
Highlights
The incidence of spinal cord lesions caused by gunshots varies considerably, depending on the country, ranging from 13 to 44%
Study undertaken in two Brazilian state capitals showed that gunshot wounds (GSWs) was the cause of 17–30% of all hospital admissions for external causes
EVALUATION OF A GUNSHOT INJURY IN THE SPINE The evaluation of a patient with a GSW should first follow the techniques of basic life support known as ‘ABCDE’
Summary
Because of the increasing violence in urban areas, gunshot wounds (GSWs) are an important cause of morbidity and mortality in the population, especially among young people (Table 1).[1,2,3,4] The incidence of penetrating injuries to the spine has increased lately,[5] and they cause 13–17% of all spine injuries.[6,7,8,9,10,11] The incidence of spinal cord lesions caused by gunshots varies considerably, depending on the country, ranging from 13 to 44%. GSWs are the most common cause of spinal cord lesions, followed by traffic accidents; in others the order is the reverse.[6,12,13,14,15]. Spinal cord lesions represented 90% of the admissions, and 80% of patients developed paraplegia or quadriplegia.[2]
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