Surgical management of missile trauma to thoraco -lumbar spine

ABSTRACT

To evaluate the optimum treatment for Spinal Missile Injury with respect to missile trajectory, functional outcome, surgical indications, and timing of surgical intervention. Analysis of the patients with spinal missile injury. This study was conducted in the Emergency Department of Assir Central Hospital Abha Kingdom of Saudi Arabia over a period of three years from June 2001 - May 2004. A prospective series of Nineteen Missile trauma patients to the Thoraco-lumbar spine is presented. A total of 20 patients [13 in the surgical group A, 7 in the conservative group B] were monitored for functional recovery. One female patient died preoperatively. Twelve were treated surgically, of whom 9 [75%] had incomplete injuries [Frankel scores B, C, and D],6 [66.66%] showed improvement, 2 [22.22%] showed no change, and 1 [11.11%] worsened[Table3] . In the conservative group, five [71.42%] had incomplete injuries, 3[60%] improved, one [20.0%] remained unchanged and one [20%] worsened. Five patients [including both groups] were with complete injury [Frankel scores A]. Mean postoperative hospital stay was 18 days. The wounds were caused by splinters in 12 [71.4%] and bullets in 7 [28.7%]. Eight patients received more than one shrapnel. Associated injuries were present in eleven patients. The best results were obtained by the patients who received operations because of rapid neurologic deterioration cauda equina compression. If spinal cord is not injured by the trajectory, the best approach is conservative. It was concluded that surgical intervention is essential for spinal gunshot injury patients with instability or rapid neurological deterioration and beneficial for patients with CSF fistula, infections and compressing foreign bodies in the injury site. The initial neurological grade was found to be the best prognostic indicator. Most of the management revolves around consequences of the neurological deficit