The role of routine spinal imaging and immobilisation in asymptomatic patients after gunshot wounds

DuBose, Joseph; Teixeira, Pedro G.R.; Hadjizacharia, Pantelis; Hannon, Matt; Inaba, Kenji; Green, D.G.; Plurad, David; Demetriades, Demetrios; Rhee, Peter

doi:10.1016/j.injury.2008.11.005

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Volume 40, Issue 8 , Pages 860-863, August 2009

The role of routine spinal imaging and immobilisation in asymptomatic patients after gunshot wounds

Joseph DuBose
- Division of Trauma and Critical Care at the Los Angeles County, University of Southern California Medical Center, Los Angeles, CA, United States
Pedro G.R. Teixeira
- Division of Trauma and Critical Care at the Los Angeles County, University of Southern California Medical Center, Los Angeles, CA, United States
Pantelis Hadjizacharia
- Division of Trauma and Critical Care at the Los Angeles County, University of Southern California Medical Center, Los Angeles, CA, United States
Matt Hannon
- Division of Trauma and Critical Care at the Los Angeles County, University of Southern California Medical Center, Los Angeles, CA, United States
Kenji Inaba
- Division of Trauma and Critical Care at the Los Angeles County, University of Southern California Medical Center, Los Angeles, CA, United States
D.G. Green
- Division of Trauma and Critical Care at the Los Angeles County, University of Southern California Medical Center, Los Angeles, CA, United States
David Plurad
- Division of Trauma and Critical Care at the Los Angeles County, University of Southern California Medical Center, Los Angeles, CA, United States
Demetrios Demetriades
- Division of Trauma and Critical Care at the Los Angeles County, University of Southern California Medical Center, Los Angeles, CA, United States
Peter Rhee
- Division of Trauma, Critical Care and Emergency Surgery, University of Arizona, Tucson, AZ, United States
- Corresponding author at: Division of Trauma, Critical Care and Emergency Surgery, University of Arizona, PO Box 245063, Tucson, AZ 85724, United States.

Accepted 7 November 2008.

Abstract

Background

The role of routine dedicated spinal imaging and immobilisation following gunshot wounds (GSW) to the head, neck or torso has been debated. The purpose of this study was to determine the incidence of spinal column injury requiring stabilisation in evaluable patients following gunshot injury.

Methods

A retrospective study from of a Level I trauma centre from January 1995 to December 2004. All patients with GSW to the head, neck or torso and bony spinal column injury underwent medical record review to determine injury type, presentation, presence of concomitant spinal cord injury, treatment and outcome.

Results

A total of 4204 patients sustaining GSW to the head, neck or torso were identified. Complete medical records were available for the 327 (7.8%) patients with bony spinal column injury. Among these patients, 173 (52.9%) sustained spinal cord injury. Two patients (0.6%) with GSW to the torso and bony spinal column injury required operative spinal intervention. The indication for operative intervention in both cases was removal of a foreign body or bony fragment for decompression of the spinal canal. None of the 4204 patients sustaining GSW to the head, neck or torso demonstrated spinal instability requiring operative intervention, and only 2/327 (0.6%) required any form of operative intervention for decompression.

Conclusion

Spinal instability following GSW with spine injury is very rare. Routine spinal imaging and immobilisation is unwarranted in examinable patients without symptoms consistent with spinal injury following GSW to the head, neck or torso.

Keywords: Trauma, Gunshot wounds, Spinal injury