Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Neurosurgery, University of Rochester, 601 Elmwood Ave., Rochester, NY 14620, USA.
Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Spine J. 2024 Sep;24(9):1553-1560. doi: 10.1016/j.spinee.2024.04.032. Epub 2024 May 11.
Gunshot wounds (GSWs) to the vertebral column represent an important cause of morbidity and mortality in the United States, constituting approximately 20% of all spinal injuries. The management of these injuries is an understudied and controversial topic, given its heterogeneity and lack of follow-up data.
To characterize the management and follow-up of GSWs to the spine.
STUDY DESIGN/SETTING: A multi-institutional retrospective review of the experience of two urban Level 1 trauma centers.
Patients with GSWs to the spine between 2010-2021.
Measures included work status, follow-up healthcare utilization, and pain management were collected.
Charts were reviewed for demographics, injury characteristics, surgery and medical management, and follow-up. Statistical analysis included T-tests and ANOVA for comparisons of continuous variables and chi-square testing for categorical variables. All statistics were performed on SPSS v24 (IBM, Armonk, NY).
A total of 271 patients were included for analysis. The average age was 28 years old, 82.7% of patients were black, 90% were male, and 76.4% had Medicare/Medicaid. The thoracic spine (35%) was most commonly injured followed by lumbar (33.9%) and cervical (25.6%). Cervical GSW was associated with higher mortality (p<.001); 8.7% of patients developed subsequent osteomyelitis/discitis, 71.3% received prophylactic antibiotics, and 56.1% of cervical GSW had a confirmed vertebral or carotid artery injury. ASIA scores at presentation were most commonly A (26.9%), D (20.7%), or E (19.6%), followed by C (7.4%) and B (6.6%). 18.8% of patients were unable to be assessed at presentation. ASIA score declined in only 2 patients, while 15.5% improved over their hospital stay. Those who improved were more likely to have ASIA B injury (p<.001). Overall, 9.2% of patients underwent spinal surgery. Of these, 33% presented as ASIA A, 21% as ASIA B, 29% as ASIA C, and 13% as ASIA D. Surgery was not associated with an improvement in ASIA score.
Given the ubiquitous and heterogeneous experience with GSWs to the spine, rigorous attempts should be made to define this population and its clinical and surgical outcomes. Here, we present an analysis of 11 years of patients presenting to two large trauma centers to elucidate patterns in presentation, management, and follow-up. We highlight that GSWs to the cervical spine are most often seen in young black male patients. They were associated with high mortality and high rates of injury to vertebral arteries and that surgical intervention did not alter rates of discitis/osteomyelitis or propensity for neurologic recovery; moreover, there was no incidence of delayed spinal instability in the study population.
枪伤（GSW）是美国发病率和死亡率的重要原因，约占所有脊柱损伤的 20%。由于其异质性和缺乏随访数据，这些损伤的管理是一个研究不足且存在争议的话题。
描述脊柱 GSW 的管理和随访情况。
研究设计/地点：对两个城市一级创伤中心的经验进行多机构回顾性分析。
2010-2021 年间脊柱 GSW 患者。
包括工作状态、随访医疗保健利用和疼痛管理等措施。
对患者的人口统计学、损伤特征、手术和医疗管理以及随访情况进行图表审查。统计分析包括 T 检验和 ANOVA 用于比较连续变量，卡方检验用于分类变量。所有统计分析均在 SPSS v24（IBM，Armonk，NY）上进行。
共纳入 271 例患者进行分析。平均年龄为 28 岁，82.7%的患者为黑人，90%为男性，76.4%为医疗保险/医疗补助。最常见的损伤部位是胸椎（35%），其次是腰椎（33.9%）和颈椎（25.6%）。颈椎 GSW 与更高的死亡率相关（p<.001）；8.7%的患者发生后续骨髓炎/椎间盘炎，71.3%接受预防性抗生素治疗，56.1%的颈椎 GSW 证实存在椎体或颈动脉损伤。就诊时的 ASIA 评分最常见为 A（26.9%）、D（20.7%）或 E（19.6%），其次为 C（7.4%）和 B（6.6%）。18.8%的患者在就诊时无法进行评估。只有 2 名患者的 ASIA 评分下降，而 15.5%的患者在住院期间有所改善。那些改善的患者更有可能患有 ASIA B 损伤（p<.001）。总体而言，9.2%的患者接受了脊柱手术。其中，33%为 ASIA A，21%为 ASIA B，29%为 ASIA C，13%为 ASIA D。手术与 ASIA 评分的改善无关。
鉴于脊柱 GSW 的普遍存在和异质性，应努力明确这一人群及其临床和手术结局。在这里，我们分析了 11 年来在两个大型创伤中心就诊的患者，以阐明就诊、治疗和随访的模式。我们强调，颈椎 GSW 多见于年轻黑人男性患者。它们与高死亡率和椎动脉损伤发生率高有关，手术干预并未改变椎间盘炎/骨髓炎的发生率或神经恢复的倾向；此外，研究人群中没有迟发性脊柱不稳定的发生。
