- Discussion:
-
general discussion of GSW:
-
care of the spine injured patient:
-
stability:
- most gun shot wounds to the spine are stable, and therefore do not require operative stabilization;
- indications for bullet removal:
- progressive neurologic deficit in any part of the spine;
- GSW which first enters the alimentary tract, since the incidence of CNS infection is high;
- high velocity GSW;
- thoracic spine:
- it appears that bullet removal may not improve neurologic outcome;
- thoracolumbar spine:
- bullet removes may improve neurologic recovery in both complete an incomplete injuries;
- this may be due to the fact that at the level of the thoracolumbar spine, there is a
predominace of peripheral nerves (cauda equina) which have a greater potential
for recovery than does the spinal cord itself;
- Complications:
- CNS infection:
- most common in GSW to the abdomen which subsequentally enter the spine;
-
syringomyelia:
- late neurologic deterioration:
- may be due to bullet fragment migration;
- pain:
- bullet fragment removal may not improve pain;
References:
Profiles of spinal cord injury and recovery after gunshot injury.
The effects of removal of bullet fragments retained in the spinal canal. A ³
collaborative study by the National Spinal Cord Injury Model Systems.
Infection about the spine associated with low-velocity-missile injury
to the abdomen.
Gunshot wounds of the spine: the effects of laminectomy.
Outcome of laminectomy for civilian gunshot injuries of the terminal
spinal cord and cauda equina: review of 88 cases.
