Gunshot Injuries of the Spine: The Outcome Assessment of Series of Twenty-One Patients

Background Data: Gunshot injuries of the spinal cord represent a complex, multidisciplinary management challenge for spine surgeons. Many unique factors can affect the decision-making and management of this controversial type of injuries. Study Design: A retrospective cohort study. Purpose: To assess the clinical outcome and complications after treating patients with gunshot injuries of the spinal cord and the thecal sac. Patients and Methods: This study included 21 patients with spinal gunshot injuries. The mean age was 30.9 ± 4.1 (range, 24–40) years; all patients were males except for one female. The American Spinal Injury Association (ASIA) scale was used to assess the initial neurological status and during the follow-up period. Twelve patients had complete spinal cord injury (CSCI), whereas nine patients had incomplete spinal cord injury (ISCI). The most common involved spinal region was the thoracic spine (52.4%), followed by the lumbar spine (28.6%), then the cervical spine (19%). Results: Fourteen patients were managed conservatively: eight (57.1%) improved, including two patients with CSCI. Seven patients were managed surgically: four (57.1%) improved, including one patient with CSCI. There was no significant difference in the final clinical outcome between the two management protocols. The mean improvement of the 12 patients who showed improvement was 1.17 ASIA grade: only two patients improved two grades (none of them had CSCI), and the other ten patients improved only one grade. The worst prognosis was the thoracic injury with the occurrence of the two follow-up deaths and the least recovery rate of 3/11 (27.3%), while the lumbar spine had the best prognosis with all six patients improving with a mean 1.3 ASIA grade improvement without any follow-up deaths. Conclusion: The clinical outcome of gunshot injuries of the spine was dependent on the initial ASIA grade and the spinal injury level, while the cauda equina injuries had a better prognosis irrespective of the management modality. (2020ESJ218)