The importance of mechanism in penetrating spinal injuries - A comparative study between gunshot wounds versus stab wounds to the spine managed at a major trauma centre in South Africa

INTRODUCTION: Although both gunshot wounds (GSW) and stab wounds (SW) can cause a penetrating spinal injury, the mechanisms underlying these injuries are distinct. This study compares spinal GSWs and SWs regarding their presenting characteristics, associated injuries, clinical management, and patient outcomes. METHODS: Longitudinal data (2012-2022) were collected from the Hybrid Electronic Medical Registry database to identify all patients with spinal GSW and SW over the study period. RESULTS: There were 201 (54%) patients with spinal GSW and 169 (46%) patients with spinal SW. Thoracic level spinal cord injury and American Spinal Injury Association Impairment Scale (AIS) grade D injury were associated with the need for spinal surgery (P < 0.05). In the SW group, three AIS E, two AIS D, two AIS C, and one AIS A patient had spinal surgery. In the GSW cohort, six of the seven patients who underwent spinal surgery had a spinal cord injury, compared to six of the eight patients in the SW group. Significantly more GSW patients underwent surgical intervention for concurrent body injuries compared to SW patients. The most common procedure in both groups was a laparotomy. Patients in the GSW group had significantly higher complication rates than the SW group and higher rates of intensive care unit (ICU) admission. The in-hospital mortality rate was approximately ten times higher in the GSW group. CONCLUSION: GSWs and SWs of the spine are distinct entities. GSWs are more likely to have severe systemic illness from concurrent organ injuries compared to SWs. In contrast, SWs are more likely to be incomplete cord injuries and carry a much better prognosis for neurological improvement/ambulation. The indications for surgery must be individualised.