Prognosis and management of spinal cord and cauda equina bullet injuries in sixty-five civilians.

Abstract

HE purpose of this study of patients with spinal cord injury was to isolate a single wounding agent, namely, bullets, and to discuss in detail one aspect of the problem, the efficacy of surgical therapy. On the basis of this analysis certain predictions as to outcome can be made and a degree of uniformity introduced into the management of this type of spinal cord injury. Material and Methods The data in this study have been gathered from 42 patients with civilian bullet injuries of the spinal cord and 23 patients with similar wounds of the conus medullaris and cauda equina. These patients were admitted consecutively after 1955 to three facilities with which the authors were associated, and 25 were under their personal care. The remainder were identified from the archives of the various institutions and then traced for follow-up. Each individual had a single bullet wound of the spinal cord or cauda equina; other types of spinal cord or cauda injuries were not included. All patients had an initial neurological deficit, which was in most cases profound. Patients had anteroposterior and lateral x-rays of the spine and usually antibiotics and tetanus prophylaxis. The familiar general problems related to acute spinal cord injury and paraplegia have been discussed in detail in other publications s,1~ and will not be emphasized in this paper. The patients were separated into four clinical groups according to the spinal cord deficit: