Spinal gunshot wounds: A retrospective, multicenter, cohort study

G Ricciardi; O Martinez; J Cabrera; J Matta; V Davila; J M Jimenez; H Vilchis; V Tejerina; J Perez; J P Cabrera; R Yurac

doi:10.1016/j.recot.2023.07.001

Spinal gunshot wounds: A retrospective, multicenter, cohort study

Rev Esp Cir Ortop Traumatol. 2023 Jul 7:S1888-4415(23)00165-0. doi: 10.1016/j.recot.2023.07.001. Online ahead of print.

[Article in English, Spanish]

Authors

G Ricciardi¹, O Martinez², J Cabrera³, J Matta⁴, V Davila⁵, J M Jimenez⁶, H Vilchis⁷, V Tejerina⁸, J Perez⁹, J P Cabrera¹⁰, R Yurac¹¹

Affiliations

¹ Centro Médico Integral Fitz Roy, Argentina. Electronic address: guillermoricciardi@gmail.com.
² Hospital Universitario Dr. José E. González, Mexico.
³ Hospital de Traumatología "Dr. Victorio de la Fuente Narvaez" IMSS, Mexico.
⁴ Hospital Militar Central, Colombia.
⁵ Hospital Universitario Dr. Manuel Nuñez Tovar, Venezuela.
⁶ Instituto Mexicano del Seguro Social, Mexico.
⁷ Unidad Médica de Alta Especialidad Hospital de Traumatología y Ortopedia Lomas Verdes IMSS, Mexico.
⁸ Hospital Traumatología y Ortopedia Magdalena de las Salinas, Mexico.
⁹ Clínica de columna "Dr. Manuel Dufoo Olvera", Mexico.
¹⁰ Hospital Clínico Regional de Concepción, Chile.
¹¹ Department of Orthopedic and Traumatology, University del Desarrollo, Santiago, Chile; Spine Unit, Department of Traumatology, Clinica Alemana, Santiago, Chile.

PMID: 37423382
DOI: 10.1016/j.recot.2023.07.001

Abstract

Introduction and objective: To describe the demographic and clinical characteristics and treatment of patients with spinal gunshot wounds across Latin America.

Material and methods: Retrospective, multicenter cohort study of patients treated for gunshot wounds to the spine spanning 12 institutions across Latin America between January 2015 and January 2022. Demographic and clinical data were recorded, including the time of injury, initial assessment, characteristics of the vertebral gunshot injury, and treatment.

Results: Data on 423 patients with spinal gunshot injuries were extracted from institutions in Mexico (82%), Argentina, Brazil, Colombia, and Venezuela. Patients were predominantly male civilians in low-risk-of-violence professions, and of lower/middle social status, and a sizeable majority of gunshots were from low-energy firearms. Vertebral injuries mainly affected the thoracic and lumbar spine. Neurological injury was documented in n=320 (76%) patients, with spinal cord injuries in 269 (63%). Treatment was largely conservative, with just 90 (21%) patients treated surgically, principally using posterior open midline approach to the spine (n=79; 87%). Injury features distinguishing surgical from non-surgical cases were neurological compromise (p=0.004), canal compromise (p<0.001), dirty wounds (p<0.001), bullet or bone fragment remains in the spinal canal (p<0.001) and injury pattern (p<0.001). After a multivariate analysis through a binary logistic regression model, the aforementioned variables remained statistically significant except neurological compromise.

Conclusions: In this multicenter study of spinal gunshot victims, most were treated non-surgically, despite neurological injury in 76% and spinal injury in 63% of patients.

Keywords: Balas; Bullet; Estudio multicéntrico; Firearms; Heridas por proyectil de arma de fuego; Lesión vertebromedular; Multicenter study; Spinal cord injury; Spinal gunshot wound; Traumatology; Traumatología.