Surgical Management of Missile Trauma to Thoraco -Lumbar Spine

Abstract

Objectives: To evaluate the optimum treatment for Spinal Missile Injury with respect to   Missile trajectory, Functional outcome, surgical indications, and timing of surgical intervention.

Study Design: Analysis of the patients with spinal missile injury. Place and Duration of Study: This study was conducted in the Emergency Department of Assir Central Hospital Abha Kingdom of Saudi Arabia over  a period of three years from June 2001 - May 2004.

Material and Methods:  A prospective series of  Nineteen Missile  trauma patients to the Thoraco-lumbar spine is presented . A total of 20 patients (13 in the surgical group A , 7  in the conservative group B)  were monitored for functional recovery. One female patient died preoperatively. Twelve  were treated surgically, of whom 9 (75%) had incomplete injuries (Frankel scores B, C, and D) ,6 (66.66%) showed improvement, 2 (22.22%) showed no change, and 1 (11.11%) worsened(Table3) . In the conservative group , five (71.42%) had incomplete injuries, 3(60%) improved, one (20.0%) remained unchanged and one (20%) worsened. Five patients (including both groups) were with complete injury (Frankel scores A).  Mean postoperative hospital stay was 18 days. The wounds were caused by splinters in 12 (71.4%) and bullets in 7 (28.7%). Eight patients received more than one shrapnel. Associated  injuries were present in eleven patients.

Results: The best results were obtained by the patients who received operations because of rapid neurologic deterioration cauda equina   compression. If spinal cord is not injured by the  trajectory,  the best approach  is conservative.

Conclusion: It was concluded that surgical intervention is  essential for spinal gunshot injury patients with instability or rapid neurological deterioration  and beneficial for patients with CSF fistula, infections and compressing foreign bodies in the injury site. The initial neurological grade was found to be the best prognostic indicator. Most of the management revolves around consequences of the neurological deficit.