n South African Journal of Surgery - Gunshot injuries of the spine - a review of 49 cases managed at the Groote Schuur Acute Spinal Cord Injury Unit : trauma
|Article Title||Gunshot injuries of the spine - a review of 49 cases managed at the Groote Schuur Acute Spinal Cord Injury Unit : trauma|
|© Publisher:||Medpharm Publications|
|Journal||South African Journal of Surgery|
|Author||J.C. Le Roux and R.N. Dunn|
|Publication Date||Nov 2005|
|Pages||165 - 168|
The Acute Spinal Injury Unit, relocated from Conradie Hospital to Groote Schuur Hospital in mid-2003, admitted 162 patients in the first year of its existence. A large number of these injuries were the result of interpersonal violence, particularly gunshot wounds. <br><I>Aim.</I> To review patients with gunshot injuries to the spine, with reference to neurological injury, associated injuries, need for surgery and complications. <br><I>Methods.</I> A comprehensive database is maintained to collect data on all spinal injury admissions. These data, as well as case notes and X-rays, were reviewed for all gunshot spine patients admitted to the Acute Spinal Injury Unit over a year. <br>Forty-nine patients were identified. Thirty-eight were male and 11 female with an average age of 27.5 years (range 15 - 51 + 8.53). The average stay in the acute unit was 30 (4 - 109 + 28) days. <br><I>Results.</I> The spinal injury was complete in 38 and incomplete in 8, with 3 having no neurological deficit. The level was cervical in 13, thoracic in 24 and lumbar in 12. Only 9 patients improved neurologically. The spine was considered stable in 43 cases. Stabilisation was performed in the 6 unstable cases. The bullets were removed in 11 cases as they were in the canal. <br>There were 55 significant associated injuries, viz. 14 haemo-pneumothoraces, 16 abdominal visceral injuries, 3 vascular injuries, 4 injuries of the brachial plexus and 3 of the oesophagus, 2 tracheal injuries, 1 soft palate injury and 11 non-spinal fractures. <BR>Complications included 3 deaths and discitis in 3 cases, pneumonia in 6 and pressure sores in 6. <br><I>Conclusion.</I> Gunshot injuries of the spine are a prevalent and resource-intensive cause of paralysis. There is a high incidence of permanent severe neurological deficit, but usually the spine remains mechanically stable. Most of the management revolves around the associated injuries and consequences of the neurological deficit.
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