Rare Injury Pattern Research Articles

Civilian Gunshot Injuries to the Spine: Diagnostic Procedures and Therapeutic Concepts

Background: While gunshot injuries to the spine represent a well-recognized entity in the United States, they remain a rare injury pattern in Central Europe. Thus, many European trauma centers lack a routine in diagnostic algorithms and therapeutic concepts for these injuries. Patients and Methods: This retrospective study was designed to analyze the overall injury pattern, the extent of spinal instability and neurologic deficit, and the incidence of spinal infections in all patients admitted to the Division of Trauma Surgery at the University Hospital of Zurich, Switzerland, between 1992 and 1999. During this 8-year period, 822 patients were admitted for spinal injuries, of which twelve cases (1.5%) were due to gunshot wounds. Of these, ten patients had a primary neurologic impairment (paraplegia: n = 7; partial neurologic deficit: n = 3), and only two patients were neurologically normal. The initial therapeutic concept consisted in stabilization of vital functions; in particular, the management of concomitant vascular, thoracic, and abdominal injuries had the highest priority. All wounds were surgically debrided and systemic antibiotics were applied for a limited time, approximately for 3 days after trauma. Laminectomies were performed in five patients. Only one patient with spinal instability required internal fixation. Results: No neurologic recovery was seen in any of the patients with primary neurologic deficits, and neither early laminectomy nor the application of steroids had a positive effect. No spinal infection was noted in any of these patients. Conclusions: We recommend early stabilization, aggressive surgical debridement, and periopertive antibiotic prophylaxis for all spinal gunshot injuries. Decompressive laminectomy and the application of steroid do not seem to have a positive effect on the neurologic recovery of these patients.

Cruciate paralysis: a clinical and radiographic analysis of injuries to the cervicomedullary junction

Fourteen patients with superior cervical spinal cord injuries and the clinical signs and symptoms of cruciate paralysis are presented. This rare injury pattern is characterized by weakness of the upper extremities with little or no compromise of lower-extremity function following trauma to the superior spinal cord. Anatomically, cruciate paralysis is thought to represent selective injury to descending corticospinal tracts as they decussate at the cervicomedullary junction. The clinical and radiographic findings of each patient are outlined and the incidence and natural history of the injury syndrome, including a review of the literature, are presented.