Surgical management of gunshot-induced spinal cord injuries: A case series analysis.

Study Design: Retrospective observational study of patients with spinal cord injuries (SCI) caused by civilian gunshot wounds (GSW) surgically treated at a tertiary hospital between 2017 and 2024. Purpose: The purpose of the study was to evaluate surgical indications, techniques, complications, and neurological outcomes in CGWSCI and assess the role of surgery in this setting. Overview of Literature: Gunshot injuries represent up to 17% of spinal cord trauma, mainly affecting young men. Civilian lesions differ from military due to reduced projectile velocity and cavitation effects. Literature shows that prognosis depends primarily on initial American Spinal Injury Association Impairment (ASIA) grade, while the neurological benefit of surgery remains controversial and potentially overestimated. Materials and Methods: Medical records of 24 patients were reviewed. Data included demographics, level of injury, projectile location, neurological status (ASIA scale), surgical procedure, intraoperative cerebrospinal fluid (CSF) leak, repair technique, complications, and neurological outcome. Statistical analysis employed Fisher's exact and Mann-Whitney tests, with significance at Results: Patients were mostly male (87.5%), mean age 29.7 years. Thoracic lesions predominated (58.3%). Projectiles were intracanal in 50% and fragments in 33.3%. At admission, 70.8% were ASIA A, and 29.2% had incomplete deficits. Neurological improvement occurred in 16.7%, exclusively in incomplete injuries, with a significant association between initial ASIA and recovery ( Conclusions: CGWSCI predominantly affect young men and often results in complete deficits, with limited potential for neurological recovery. Surgery did not benefit ASIA A patients but may aid selected cases with incomplete deficits, neural compression, instability, or CSF fistula. Initial ASIA grade remains the strongest prognostic factor.