There is a very limited role for surgery in the management of gunshot wounds to the spine - A South African experience

PURPOSE: Spinal gunshot wounds (GSW) are relatively uncommon but can be both devastating and life-changing. The exact role of surgery remains unclear. This study reviews our institutional experience with spinal GSW management and examines the clinical outcome of these patients in a developing world setting. METHODS: A retrospective study was conducted over a 10-year period from December 2012 to December 2022 at a major trauma centre in South Africa. All patients who sustained spinal GSW were included. RESULTS: 201 patients with a spinal GSW were included (male: 89%, mean age: 31 years, median Injury Severity Score (ISS): 16). AIS classifications: E (60%), A (20%), B (8%), D (7%), and C (3%). All patients underwent a CT scan, and 65% had an MRI. In 95% there was a bony spine injury, and in 37% a spinal cord injury. 3% of all patients underwent surgical intervention. A management algorithm for spinal GSW patients is detailed in Fig. 2. Overall, 18% of patients required admission to the intensive care unit (ICU), and 23% had one or more complications. Common complications included hospital-acquired pneumonia and acute kidney injury. The overall in-hospital mortality rate was 11% (23/201). Of the 178 patients who survived to hospital discharge, 73% were discharged for ongoing spinal rehabilitation, and the remainder were discharged home. CONCLUSION: Although spinal GSWs are morbid with devastating consequences, there is a very limited role for spinal surgery, as neurological recovery is unlikely to improve. Non-operative management may be of benefit in resource-constrained public healthcare facilities. Future research should focus on refining the indications for surgical intervention in this patient cohort.