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Gun Shot Wounds to the Spine

- 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


Profiles of spinal cord injury and recovery after gunshot injury.

The effects of removal of bullet fragments retained in the spinal canal. A 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.