Low-velocity civilian gunshot wounds of the spine

This article describes a retrospective study on patients admitted to a level I trauma center between 1989 and 1993 with low-velocity gunshot wounds to the spine. Medical records and imaging studies were reviewed to determine patient demographics, neurologic deficit, prophylactic antibiotic administration, and rate of infection, spine stability, and principle associated injuries. A total of 37 patients with low-velocity gunshot wounds to the spine were identified and comprised 34% of all spinal injury patients. Neurologic outcome of the low-velocity gunshot wound to the spine depended on the level of the injury and the presenting neurologic deficit, as improvement of one or two Frankel grades occurred in only seven patients. Prophylactic antibiotics were given to 20 patients, and one infection occurred and was associated with colon perforation. In the absence of hollow viscus perforation, antibiotic prophylaxis did not appear beneficial. Spinal instability was noted in three patients with cervical injury and one patient with lumbar injury, and neurologic deficit was variable despite the presence of instability. The major associated injury was vascular occlusion or disruption in 8 of 12 (66%) cervical low-velocity gunshot wounds to the spine.