Management of civilian ballistic injuries to the spine: practice patterns and recovery outcomes at a level 1 trauma center.

Background: The management of gunshot wounds to the spine remains controversial, given the limited number of cases, variability of injuries, and lack of standard treatment protocols. This study presents data from a major urban, academic, level 1 U.S. trauma center, with the aim of investigating the management pathways of spinal gunshot wounds. Methods: We performed a retrospective single-center study spanning from 2011-2023. Thirty-nine patients with gunshot wounds to the spine were identified. Results: Patients were predominantly male (92.3%) with a mean age of 25 years. Demographics included Black (78.4%), Hispanic (18.9%), and Caucasian (2.7%). American Spinal Injury Association Impairment Scale (AIS) scores on presentation were: 31.6% A, 0.0% B, 5.3% C, 18.4% D, 44.7% E. The primary location of the lodged bullet was the lumbar spine (45.5%), followed by thoracic (27.3%) and cervical (21.2%). Prophylactic antibiotics were used in 79.5%. Of the patients, 12.8% developed wound infections unrelated to the spinal column. Four patients underwent surgery (10.3%). The remaining five patients (12.8%) were managed without bracing. Outcomes upon discharges were: modified Rankin scale (mRS) of 0-2 (47.4%) or 3-4 (44.7%), AIS A (23.7%), C (7.9%), D (23.7%) and E (44.7%), with 44.1% sensation intact. Motor status from presentation to discharge was largely unchanged in 40.0% compared to worse or improved (10.0% each). Median follow-up was 2.1 months (0.9-11.6 months), with unchanged AIS scores. There was considerable variation within AIS category D. Conclusions: Most patients were managed conservatively, with largely unchanged functional outcomes. Further studies with a larger sample size and standardized data collection may provide further insight to determine the efficacy of treatment options of gunshot wounds to the spine.