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


CONCLUSIONS
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.
Division of Trauma and Critical Care at the Los Angeles County, University of Southern California Medical Center, Los Angeles, CA, USA.
Joseph
J
DuBose
Pedro G R
PG
Teixeira
Pantelis
P
Hadjizacharia
Matt
M
Hannon
Kenji
K
Inaba
D G
DG
Green
David
D
Plurad
Demetrios
D
Demetriades
Peter
P
Rhee
D000328:Adult; D002574:Cervical Vertebrae / Q000293:injuries; D019299:Decompression, Surgical; D006801:Humans; D007103:Immobilization / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D013124:Spinal Injuries / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D014193:Trauma Centers; D016896:Treatment Outcome; D014948:Wounds, Gunshot / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy