Surgery is associated with a greater likelihood of neurologic recovery in patients with gunshot wound induced injuries to the thoracic and lumbar spine

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Brian Goh (Boston, USA) speaks to Spinal News International about the results of a study that aimed to better understand the impact of surgical intervention in patients who sustained gunshot wound induced spinal injuries (GSIs), the results of which he presented at the North American Spine Society’s (NASS) Spine Across the Sea meeting (5—8 July, Hawaii, USA).

“It is important for us to study this topic as the number of GSIs, at least in the United States, has been increasing in proportion,” says Goh, who adds that currently there are some “guidelines that surgeons use to indicate for surgical intervention,” such as worsening neurologic function or instability of the spinal column, but states that there is no clear consensus on management of GSIs.

Out of the nearly 32,000 spinal cord injury patients in the National Spinal Cord Injury Statistical Center (NSCISC) database, 961 were included in the study who had sustained gunshot induced spinal injuries and had complete data at one-year follow-up.

Functional assessments included the American Spinal Injury Association (ASIA) Impairment scale at presentation and at follow up. The study found that 34.2% of patients who underwent surgery had an improvement in ASIA Impairment as compared to 20.6% of patients without surgical intervention, equating to a nearly two times greater likelihood of neurologic improvement with surgery.

Further subgroup analysis showed ASIA Impairment improvements with surgery were for patients with thoracic and lumbar GSIs. However, there was no difference in ASIA Impairment in patients with cervical GSIs.

Although this data from a large cohort of patients “lacks granularity,” notes Goh, it is just “one piece of the puzzle” in determining what the guidelines for surgical intervention should be in relation to those with GSIs and will “hopefully be part of the decision making process for surgeons” going forward.


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