Gonzalo Bertullo, Hildo RC Azevedo-Filho, Nivaldo S de Almeida, Paulo Thadeu Brainer-Lima, Renata Azevedo, Fernanda Azevedo
Abstract
Retrospective cohort comparison study of gunshot wounds to the spine using available information gathered at two large urban trauma centers between 2009 and 2015. There are up to 33,000 cases of gunshot wounds to the spine annually in the United States, the majority of which resolve non-surgically. Despite this, they continue to be neurologically devastating, carrying long-lasting healthcare expenditures of, on average, two million dollars in direct and indirect costs, considerable physical and emotional burden for both the patient and family, and global societal impact. The epidemiology for spinal gunshot injuries is minimally understood, has been mostly described outside of the United States, and involves conflicting results, with regards to behaviors contributing to risk and the mortality rates associated with these injuries. The majority of retrospective studies address contamination with ballistic fragments and the risk or recovery associated with spinal infections. This study will determine the neurologic deficit (Asia Impairment Scale and American Spinal Injury Association scores), mortality, and surgical intervention rates associated with spinal gunshot wounds for several psychological and physical clinical carnage profiles. Materials and Methods: Gunshot wounds to the spine using available information gathered at two large urban trauma centers between 2009 and 2015. Information that was accessed for patients whose care was given at the centers was collected from pre-admission, admission, surgical, and discharge records; also comprising demographics, endocrinologic androgen levels, Alcohol Use Disorders Identification Test (AUDIT), Dead and Cytoplasmic sperm reserves (DCSR), DSCS > 50% decrease, Basics Oriented Alcohol Screening Test (FAST), Active Duty military status, pre-injury physical profile, mechanism of injury, discharge American Spinal Injury Association (ASIA) Impairment Scale, and hospital and intensive care unit (ICU) length of stay.
Keywords: Gunshot wound; Gunshot wound to the spine; Spinal cord injury; Traumatic injury to the spine
References
1. Roye WP, Dunn EL, Moody JA. Cervical spinal cord injury—a public catastrophe. Trauma 1988;28:1260-1264.
2. Farmer JC, Vaccaro AR, Balderston RA, Albert TJ, Cotler J. The changing nature of admission to a spinal cord injury center: violence on the rise. J Spinal Disord 1998;11:400-403.
3. Tator CH. Classification of spinal cord injury based on neurological presentation. In: Narayan RK, Wilberger JE, Povlishock JT, eds. Neurotrauma. New York: McGraw-Hill; 1996:1059-1073.
4. Guttmann L. Spinal cord injuries: comprehensive management and research. 2d ed. Oxford: Blackwell Scientific Publications; 1976.
5. Ducker TB, Lucas JT, Wallace CA. Recovery from spinal cord injury. In: Weiss MH, ed. Clinical neurosurgery. Baltimore: Williams & Wilkins; 1982:495-513.
6. Ohry A, Ohry-Kossoy K. Spinal cord injuries in the 19th century: background, research and treatment. Edinburgh: Churchill Livingstone; 1989.
7. Sonntag VKH. History of degenerative and traumatic diseases of the spine. In: Greenblat SH, Epstein MH, eds. A history of neurosurgery in its scientific and professional contexts. Park Ridge: American Association of Neurological Surgeons; 1997:355-371.
8. Gobo DJ. Localization techniques. neuroimaging and electroencephalography. In: Greenblat SH, Epstein MH, eds. A history of neurosurgery in its scientific and professional contexts. Park Ridge: American Association of Neurological Surgeons; 1997:223-446.
9. Cushing H. Haematomyelia from gunshot wounds to the cervical spine. Acta Chir Scand 1897;8:195-197.
10. Cushing H. Haematomyelia from gunshot wounds to the spine: a report of two cases with recovery following symptoms of hemilesion of the cord. Am J Med Sci 1898;115:654-683.
11. Matson DM. The treatment of acute compound injuries of the spinal cord due to missiles. Springfield, IL: Charles Thomas; 1948.
12. Spurling RG. The European Theater of operations. In: Woodhall B, ed. Neurosurgery. Washington: US Government Printing Office; 1959.
13. Hammoud MA, Haddad FS, Moufarrij NA. Spinal cord missile injuries during the Lebanese civil war. Surg Neurol 1985;43:432-442.
14. Ohry A, Rozin R. Acute spinal cord injuries in the Lebanon war. Israel J Med Sci 1984;20:345-349.
15. Aaarabi B, Alibaii E, Taghipur M, Kamgarpur A. Comparative study of functional recovery for surgically explored and conservatively managed spinal cord missile injuries. Neurosurgery 1996;39:1133-1140.
16. Splavski B, Vranković D, Sarić G, et al. Early management of war missile spine and spinal cord injuries: experience with 21 cases. Injury 1996;27:699-702.
17. Six E, Alexander E, Kelly DL. Gunshot wounds to the spinal cord. South Med J 1979;72:699-702.
18. Miller CA. Penetrating wounds of the spine. In: Wilkins RH, Rengashary SS, eds. Neurosurgery. Vol. 1. San Francisco: McGraw- Hill; 1985:1746–8.
19. Stauffer ES, Wood RW, Kelly EG. Gunshot wounds of the spine: effects of laminectomy. J Bone Joint Surg Am 1979;61:389-392.
20. Simpson RK, Venger BH, Narayan RK. Penetrating spinal cord injury in a civilian population: a retrospective analysis. Surg Forum 1986;37:494-496.
21. Jacobson AS, Borg E. Spinal cord injury in vietnamese combat. Paraplegia 1970;7:263-281.
22. Meirowsky AM. Penetrating spinal cord injuries. In: Coates J, Meirowsky AM, eds. Neurological surgery of trauma. Washington: US Government Printing Office; 1965:257-344.
23. Demetriades D, Theodorou D, Cornwell E, et al. Transcervical gunshot injuries: mandatory operation is not necessary. J Trauma 1996;40:758-760.
24. Kupcha PC, An HS, Cotler JM. Gunshot wounds to the cervical spine. Spine 1990;15:1058-1063.
25. Yashon D. Spinal injury. New York: Appleton; 1978.
26. Benzel EC, Hadden TA, Coleman JE. Civilian gunshot wounds to the spinal cord and cauda equina. Neurosurgery 1987; 20:281-285.
27. Heiden JS, Weiss MH, Rosenberg AW, Kurze T, Apuzzo ML. Penetrating gunshot wounds of the cervical spine in civilians. J Neurosurg 1975; 42:575-579.
28. Yoshida GM, Garland D, Waters RL. Gunshot wounds to the spine. Orthop Clin North Am 1995; 26:109-116.
29. Azevedo-Filho H, Martins C, Carneiro-Filho G, Azevedo R, Azevedo F. Gunshot Wounds to the Spine: Study of 246 Patients. Neurosurgery Quarterly 2001;11:199-208. [Abstract/Full-Text]
30. Bailey RW. Fractures and dislocations of the cervical spine. In: Cervical Spine Research Society, eds. The cervical spine. Philadelphia: Lea and Febiger; 1974:116-145.
31. White AA, Johnson RM, Panjabi MM, Southwick WO. Biomechanical analysis of clinical spine stability in the cervical spine. Clin Orthop 1975; 109:85-95.
32. Denis F. The three column spine and its significance in the classification of acute toracolumbar spinal injuries. Spine 1983; 8:817-831.
33. Roy-Camille R, Saillant G, Mazel C. Internal fixation of the unstable cervical spine by posterior osteosynthesis with plates and screws. In: Cervical Spine Research Society, eds. The cervical spine. 2d ed. Philadelphia: Lippincott; 1989:390-403.
34. Cybulski GR, Stone JL, Kant R. Outcome of laminectomy for civilian gunshot injuries of the terminal spinal cord and cauda equina: review of 88 cases. Neurosurgery 1989; 24:392-397.
35. Velmahos G, Demetriades D. Gunshot wounds to the spine: should retained bullets be removed to prevent infection? Ann R Coll Surg Engl 1994;76:85-87.
36. Levy ML, Gans W, Wijesinghe HS, et al. Use of methylprednisolone as an adjunct in the management of patients with penetrating spinal cord injury: outcome analysis. Neurosurgery 1996; 39:1141-1149.
37. Heary RF, Vaccaro AR, Mesa JJ, et al. Steroids and gunshot wounds to the spine. Neurosurgery 1997; 41:576-584.
38. Mckinley W, Cifu D, Keyser ML, Wilson K. Comparison of rehabilitation outcomes in violent versus non-violent traumatic spinal cord injury. J Spinal Cord Med 1998; 21:32-36.
39. Simpson RK, Venger BH, Narayan RK. Treatment of acute penetrating injuries of the spine: a retrospective analysis. J Trauma 1989; 29:42-46.
40. Yashon D, Jane DA, White RJ. Prognosis and management of spinal cord and cauda equina bullet injuries in sixty-five civilians. J Neurosurg 1970; 32:163-170.
41. Demuth WE. Bullet velocity as determinants of wound capability: an experimental study. J Trauma 1966; 6:222-232.
42. Harvey Cushing Society. A bibliography of the writings of Harvey Cushing. 3d ed. Park Ridge: American Association of Neurological Surgeons; 1993.
43. Frankel HL, Hancock DO, Hyslop G, et al. The value of the postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. Spine 1969; 7:179-192.
44. Robertson DP, Simpson RK. Penetrating injuries restricted to the cauda equina: a retrospective review. Neurosurgery 1996; 31:265-270.
