Clinical course of pediatric gunshot wounds involving the spine and spinal cord: the Miami experience

Victor M. LuDepartments of Neurological Surgery and
Department of Neurological Surgery, Nicklaus Children’s Hospital, Miami, Florida

Search for other papers by Victor M. Lu in
jns
Google Scholar
PubMed
Close
 MD, PhD
,
Victoria A. Pinilla EscobarPediatric Surgery, University of Miami, Jackson Memorial Hospital, Miami; and

Search for other papers by Victoria A. Pinilla Escobar in
jns
Google Scholar
PubMed
Close
 MPH, CPH
,
Rebecca A. SaberiPediatric Surgery, University of Miami, Jackson Memorial Hospital, Miami; and

Search for other papers by Rebecca A. Saberi in
jns
Google Scholar
PubMed
Close
 MD, MSPH
,
Gareth P. GilnaPediatric Surgery, University of Miami, Jackson Memorial Hospital, Miami; and

Search for other papers by Gareth P. Gilna in
jns
Google Scholar
PubMed
Close
 MD
,
Joshua D. BurksDepartments of Neurological Surgery and

Search for other papers by Joshua D. Burks in
jns
Google Scholar
PubMed
Close
 MD
,
Toba N. NiaziDepartments of Neurological Surgery and
Department of Neurological Surgery, Nicklaus Children’s Hospital, Miami, Florida

Search for other papers by Toba N. Niazi in
jns
Google Scholar
PubMed
Close
 MD
,
Chad M. ThorsonPediatric Surgery, University of Miami, Jackson Memorial Hospital, Miami; and

Search for other papers by Chad M. Thorson in
jns
Google Scholar
PubMed
Close
 MD, MSPH
, and
Heather J. McCreaDepartments of Neurological Surgery and
Department of Neurological Surgery, Nicklaus Children’s Hospital, Miami, Florida

Search for other papers by Heather J. McCrea in
jns
Google Scholar
PubMed
Close
 MD, PhD
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $525.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $624.00
USD  $45.00
USD  $525.00
USD  $624.00
Print or Print + Online Sign in

OBJECTIVE

Civilian gunshot wounds (GSWs) involving the skeletal spine and spinal cord in pediatric patients are fortunately rare. Nevertheless, their presentation mandates judicious evaluation, and their clinical outcomes remain poorly defined. Thus, the authors aimed to characterize the clinical course of this traumatic presentation in the pediatric population based on their institutional experience.

METHODS

A retrospective review of a level I trauma center database was performed for the period 2011–2021. Clinical data were included for patients aged ≤ 18 years who had presented with radiographic and clinical evidence of a GSW to the spine and had at least one documented follow-up at least 6 months after injury. The primary outcomes of the study were the categorization of gunshot injuries and the results of neurological and functional examinations.

RESULTS

A total of 13 patients satisfied the study selection criteria. The mean patient age was 15.7 ± 1.6 years, and all presentations were assault in nature. Most of the patients were male (n = 12, 92%) in gender, Black in race (n = 11, 85%), and from zip codes with a median household income below the local county average (n = 10, 77%). All patients presented with a minimum Glasgow Coma Scale score of 14. Examination at presentation revealed American Spinal Injury Association Impairment Scale (AIS) grade A in 3 cases (23%), grade B in 2 (15%), grade C in 1 (8%), grade D in 2 (15%), and grade E in 5 (38%). Gunshot injury involved all regions of the spine, most commonly the cervical and thoracic spine (n = 6 for each, 46%). In terms of skeletal injury, the most common injuries were to the facet (n = 10, 77%) and the pedicle (n = 8, 62%), with evidence of intracanal injury in 9 patients (69%). Neurosurgical intervention was pursued in 1 patient (8%). Overall, 7 patients (54%) experienced a complication during admission, and the median length of hospitalization was 12 days (range 1–88 days) without any mortality events. Within 90 days from discharge, 2 patients (15%) were readmitted to the hospital for further care. The mean follow-up was 28.9 months (range 6–74 months), by which only 1 patient (8%) had an improved AIS examination; all other patients remained at their initial AIS grade.

CONCLUSIONS

Pediatric GSWs involving the spine are typically nonfatal presentations, and their long-term functional outlook appears contingent on clinical examination findings at initial presentation. Although neurosurgical intervention is not necessary in most cases, judicious evaluation of radiographic and clinical examinations by a neurosurgical team is strongly recommended to optimize recovery.

ABBREVIATIONS

AIS = American Spinal Injury Association Impairment Scale; GCS = Glasgow Coma Scale; GSW = gunshot wound; ICU = intensive care unit; LOS = length of stay; mRS = modified Rankin Scale.
  • Collapse
  • Expand

Figure from Candela-Cantó et al. (pp 61–70).

  • 1

    Bumpass DB, Buchowski JM, Park A, et al. An update on civilian spinal gunshot wounds: treatment, neurological recovery, and complications. Spine (Phila Pa 1976). 2015;40(7):450461.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Platt A, Dafrawy MHE, Lee MJ, Herman MH, Ramos E. Gunshot wounds to the lumbosacral spine: systematic review and meta-analysis. Global Spine J. 2022;12(6):12471253.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3

    Haffner DL, Hoffer MM, Wiedbusch R. Etiology of children’s spinal injuries at Rancho Los Amigos. Spine (Phila Pa 1976). 1993;18(6):679-684.

    • Search Google Scholar
    • Export Citation
  • 4

    Goldstick JE, Cunningham RM, Carter PM. Current causes of death in children and adolescents in the United States. N Engl J Med. 2022;386(20):19551956.

  • 5

    Babashahi A, Taheri M. Kyphotic deformity after laminectomy surgery for a gunshot wound to the spine: a case report. J Spine Surg. 2016;2(1):6468.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6

    Tajdine MT, Sijelmassi N. Thoracic gunshot wound: a pediatric case. Article in French. Arch Pediatr. 2012;19(1):7779.

  • 7

    Brewer JW Jr, Cox CS, Fletcher SA, Shah MN, Sandberg M, Sandberg DI. Analysis of pediatric gunshot wounds in Houston, Texas: a social perspective. J Pediatr Surg. 2019;54(4):783791.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Carreon LY, Glassman SD, Campbell MJ. Pediatric spine fractures: a review of 137 hospital admissions. J Spinal Disord Tech. 2004;17(6):477482.

  • 9

    US Census Bureau. Income. Accessed September 21, 2022. https://www.census.gov/topics/income-poverty/income.html

  • 10

    Kirshblum SC, Burns SP, Biering-Sorensen F, et al. International standards for neurological classification of spinal cord injury (revised 2011). J Spinal Cord Med. 2011;34(6):535546.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke. 1988;19(5):604607.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12

    Woodruff G, Palmer L, Fontane E, et al. Nine years of pediatric gunshot wounds: a descriptive analysis. Prev Med Rep. 2022;28:101890.

  • 13

    Taylor JS, Madhavan S, Han RW, Chandler JM, Tenakoon L, Chao S. Financial burden of pediatric firearm-related injury admissions in the United States. PLoS One. 2021;16(6):e0252821.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Aryan HE, Amar AP, Ozgur BM, Levy ML. Gunshot wounds to the spine in adolescents. Neurosurgery. 2005;57(4):748752.

  • 15

    von Scheven E. Pediatric bone density and fracture. Curr Osteoporos Rep. 2007;5(3):128134.

  • 16

    Ge L, Jubril A, Mesfin A. Civilian gun shot wounds associated with spinal injuries. Global Spine J. 2022;12(7):14281433.

  • 17

    Waters RL, Adkins RH. The effects of removal of bullet fragments retained in the spinal canal. A collaborative study by the National Spinal Cord Injury Model Systems. Spine (Phila Pa 1976). 1991;16(8):934-939.

    • Search Google Scholar
    • Export Citation
  • 18

    Goh BC, Striano BM, Crawford AM, et al. Surgical intervention is associated with improvements in the ASIA Impairment Scale in gunshot-induced spinal injuries of the thoracic and lumbar spine. Clin Spine Surg. 2022;35(7):323327.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Dwornik JJ, O’Neal ML, Ganey TM, Slater-Haase AS, Ogden JA, Wagner CE. Metallic dissolution of a civil war bullet embedded in a sternum. Am J Forensic Med Pathol. 1996;17(2):130135.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20

    Venger BH, Simpson RK, Narayan RK. Neurosurgical intervention in penetrating spinal trauma with associated visceral injury. J Neurosurg. 1989;70(4):514518.

  • 21

    Clasper JC, Hill PF, Watkins PE. Contamination of ballistic fractures: an in vitro model. Injury. 2002;33(2):157160.

  • 22

    Bartlett CS, Helfet DL, Hausman MR, Strauss E. Ballistics and gunshot wounds: effects on musculoskeletal tissues. J Am Acad Orthop Surg. 2000;8(1):2136.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    McDonald JW, Sadowsky C. Spinal-cord injury. Lancet. 2002;359(9304):417425.

  • 24

    Eckert MJ, Martin MJ. Trauma: spinal cord injury. Surg Clin North Am. 2017;97(5):10311045.

  • 25

    Chlan KM, Zebracki K, Vogel LC. Spirituality and life satisfaction in adults with pediatric-onset spinal cord injury. Spinal Cord. 2011;49(3):371375.

  • 26

    January AM, Zebracki K, Chlan KM, Vogel LC. Symptoms of depression over time in adults with pediatric-onset spinal cord injury. Arch Phys Med Rehabil. 2014;95(3):447454.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 1401 1401 148
Full Text Views 237 237 19
PDF Downloads 147 147 29
EPUB Downloads 0 0 0