title: Gunshot wounds to the spine in adolescents.
abstract: OBJECTIVE
  The incidence of spinal instability after penetrating gunshot wounds to the spine in adolescents is unknown. We describe our experience over a 15-year period.
  
  
  METHODS
  Hospital records were reviewed retrospectively. After injury and emergency care, patients were transferred to a rehabilitation facility. Examinations were completed using the American Spinal Injury Association and Frankel scales on admission, discharge, and 6 and 12 months after injury. Severity of injury was described by: 1) degree of neurological damage, 2) degree of preserved neurological function, and 3) presence of instability.
  
  
  RESULTS
  Sixty patients were identified with a mean age 15.6 years (+/- 2.7 yr). Twelve patients had cervical, 31 thoracic, and 17 lumbosacral injuries. No operative treatments were used in their care. Thirty-four patients had complete neurological deficits. Mean acute hospitalization was 21.1 days (+/- 22.8 d), and mean rehabilitation stay was 86.3 days (+/- 48.9 d), for a total hospitalization of 107.4 days (+/- 65.9 d). At 1 year, 19 patients were ambulatory and 53 were autonomous. Despite the presence of bony involvement in all, no evidence of spinal instability was noted on follow-up dynamic imaging. Even in two patients with apparent two-column disruption, no instability was noted. At 1-year follow-up, significant (nonfunctional) improvement was noted in the neurological examination (P < 0.0001). Improvements were most notable in those patients with cervical injuries, followed by thoracic and lumbar injuries.
  
  
  CONCLUSIONS
  After penetrating gunshot wounds to the spine, patients at 1-year follow-up examinations have evidence of significant, but nonfunctional, improvement. No evidence of spinal instability was noted in this study, and no surgical intervention was required.
authors.affiliation: Division of Neurosurgery, University of California, San Diego, California, USA.
authors.forename: Henry E
authors.initials: HE
authors.lastname: Aryan
authors.forename: Arun P
authors.initials: AP
authors.lastname: Amar
authors.forename: Burak M
authors.initials: BM
authors.lastname: Ozgur
authors.forename: Michael L
authors.initials: ML
authors.lastname: Levy
mesh_terms: D000293:Adolescent; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging; D002648:Child; D005500:Follow-Up Studies; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging; D011859:Radiography; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000628:therapy; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging; D015599:Trauma Severity Indices; D014948:Wounds, Gunshot / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000628:therapy