Gunshot injuries of the spine - a review of 49 cases managed at the Groote Schuur Acute Spinal Cord Injury Unit : trauma

ABSTRACT

The Acute Spinal Injury Unit; relocated from Conradie Hospital to Groote Schuur Hospital in mid-2003; admitted 162 patients in the first year of its existence. A large number of these injuries were the result of interpersonal violence; particularly gunshot wounds. Aim. To review patients with gunshot injuries to the spine; with reference to neurological injury; associated injuries; need for surgery and complications. Methods. A comprehensive database is maintained to collect data on all spinal injury admissions. These data; as well as case notes and X-rays; were reviewed for all gunshot spine patients admitted to the Acute Spinal Injury Unit over a year. Forty-nine patients were identified. Thirty-eight were male and 11 female with an average age of 27.5 years (range 15 - 51 + 8.53). The average stay in the acute unit was 30 (4 - 109 + 28) days. Results. The spinal injury was complete in 38 and incomplete in 8; with 3 having no neurological deficit. The level was cervical in 13; thoracic in 24 and lumbar in 12. Only 9 patients improved neurologically. The spine was considered stable in 43 cases. Stabilisation was performed in the 6 unstable cases. The bullets were removed in 11 cases as they were in the canal. There were 55 significant associated injuries; viz. 14 haemo-pneumothoraces; 16 abdominal visceral injuries; 3 vascular injuries; 4 injuries of the brachial plexus and 3 of the oesophagus; 2 tracheal injuries; 1 soft palate injury and 11 non-spinal fractures. Complications included 3 deaths and discitis in 3 cases; pneumonia in 6 and pressure sores in 6. Conclusion. Gunshot injuries of the spine are a prevalent and resource-intensive cause of paralysis. There is a high incidence of permanent severe neurological deficit; but usually the spine remains mechanically stable. Most of the management revolves around the associated injuries and consequences of the neurological deficit