BACKGROUND: Gunshot wound (GSW) injuries are among the leading causes of penetrating spinal column injury (pSI). pSI patients often have concurrent polytrauma that complicate management.
METHODS: We retrospectively reviewed charts between January 2012 to June 2018 at an urban Level 1 Trauma Center and analyzed bracing and surgical indications, antibiotic and MRI use, and patient outcomes.
RESULTS: We identified 100 pSI patients with an average age of 27.2 years (range 15-58). Five patients had knife injuries and 95 suffered GSW. Polytrauma occurred in 90% of patients with an average of 3.39 bullets per patient (range 1-23). Fourteen patients underwent either decompressive surgery (n=8) or decompression and fusion (n=6). Thirty-five patients were externally braced. 43% of patients presented as ASIA-A compared to 26% who were intact. While 14 patients received prophylactic antibiotics for retained bullets or durotomies, only two patients had postoperative wound infections and four had extraspinal infections from retained bullets. All inpatient mortalities (n=5) were patients with cervical pSI. Thirteen GSW patients obtained MRI scans without complications. Among our cohort, only 65 patients had followup with a median followup period of 1.25 (range 1-60) months.
CONCLUSIONS: Management of pSI in urban trauma centers is complex, as these victims routinely have polytrauma that take precedence. Indications for surgical intervention are narrow and secondary to surgery for polytrauma. External bracing may be overutilized. The efficacy of prophylactic antibiotics remains unclear. MRI can contribute valuable information but is limited by uncertainty regarding bullet compatibility. Lack of follow-up limits study of this population.