Objective: Although gunshot injuries to the spine and spinal cord are usually not fatal, but these are associated with significant morbidities. The management of spinal gunshot wounds (SGW) is controversial. Some surgeons prefer early surgery, while others recommend late surgery, if necessary. The aim of this study was to analyse the results of patients who underwent treatment for SGW and discuss this with the current literature. Materials and Methods: A retrospective study of SGW patients treated at a single institution was conducted. The study included a total of 32 patients over a 10-year period. Preoperative and early postoperative clinical and radiological data were analysed with the surgical technique used during the management of patients. Results: Overall, 27 patients underwent surgical treatment and five patients underwent conservative management. The mean follow-up duration was 12±4 months. Eighteen patients were injured by bullet, while 14 patients were injured by shrapnels. Injury occurred at lumbar spine in 17 patients, thoracolumbar region in six, cervical spine in five, thoracic spine in three and lumbosacral region in one patient. Five patients underwent continuous lumbar drainage and cerebrospinal fluid (CSF) infection was seen in two patients. However, no patient died at the end of treatment period. Conclusion: Patients with SGW should undergo comprehensive clinical and radiological assessments for surgical treatment. The main indications for early surgical intervention are CSF fistula and progressive neurological deficits. Stabilisation surgery should be the treatment option for patients with spinal instability.


Abbas A, Aziz HF, Rizvi R, Rehaman L, Javeed F, Afzal A. Gunshot acquired spinal cord injury in civilians. Turk Neurosurg. 2019;29:506-12.

Escamilla JAC, Ross JÁG, Atanasio JMP, Martínez GC, Cisneros AG, Avila JJ. Spinal gunshot wounds: Pattern and associated lesions in civilians. Asian Spine J. 2018;12:648-55.

Alaca R, Yilmaz B, Goktepe AS, Yazicioglu K, Gunduz S. Military gunshot wound-induced spinal cord injuries. Mil Med. 2002;167:926-8.

Bono CM, Heary RF. Gunshot wounds to the spine. Spine J. 2004;4:230-40.

Kitchel SH. Current treatment of gunshot wounds to the spine. Clin Orthop Relat Res. 2003;408:115-9.

Jakoi A, Iorio J, Howell R, Zampini JM. Gunshot injuries of the spine. Spine J. 2015;15:2077-85.

Kahraman S, Gonul E, Kayali H, Sirin S, Duz B, Beduk A, et al. Retrospective analysis of spinal missile injuries. Neurosurg Rev. 2004;27:42-5.

Duz B, Cansever T, Secer HI, Kahraman S, Daneyemez MK, Gonul E. Evaluation of spinal missile injuries with respect to bullet trajectory, surgical indications and timing of surgical intervention: a new guideline. Spine (Phila Pa 1976). 2008;33:E746-53.

Le Roux JC, Dunn RN. Gunshot injuries of the spine--a review of 49 cases managed at the Groote Schuur Acute Spinal Cord Injury Unit. S Afr J Surg. 2005;43:165-8.

Bilgiç S, Yurttaş Y, Özkan H, Kürklü M, Erşen Ö, Şehirlioğlu A. Omurga ateşli silah yaralanmalarında erken dönem sonuçlarımız. The Journal of Turkish Spinal Surgery. 2008;19:407-16.

Şehirlioğlu A, Aydoğan N, Kırdemir V, Ateşalp S. Treatment principles in spinal fractures due to gunshot wounds. JTSS. 1994;5:115-7.

Izci Y, Tehli O. Terörde ve savaşta kraniyal ve spinal kord yaralanmaları. Okmeydanı Tıp Dergisi. 2017;33:21-39.

de Barros Filho TE, Cristante AF, Marcon RM, Ono A, Bilhar R. Gunshot injuries in the spine. Spinal Cord. 2014;52:504-10.

Isiklar ZU, Lindsey RW. Gunshot wounds to the spine. Injury. 1998;29(Suppl 1):SA7-12.

Beaty N, Slavin J, Diaz C, Zeleznick K, Ibrahimi D, Sansur CA. Cervical spine injury from gunshot wounds. J Neurosurg Spine. 2014;21:442-9.

Kaya S, Yilmaz ND, Pusat S, Kural C, Kirik A, Izci Y. Double foramen transversarium variation in ancient Byzantine cervical vertebrae: preliminary report of an anthropological study. Turk Neurosurg. 2011;21:534-8.

Baysefer A, Akay KM, Izci Y, Kayali H, Timurkaynak E. The clinical and surgical aspects of spinal tumors in children. Pediatr Neurol. 2004;31:261-6.

Canbay S, Gürer B, Bozkurt M, Comert A, Izci Y, Başkaya MK. Anatomical relationship and positions of the lumbar and sacral segments of the spinal cord according to the vertebral bodies and the spinal roots. Clin Anat. 2014;27:227-33.

Secer HI, Solmaz I, Anik I, Izci Y, Duz B, Daneyemez MK, et al. Surgical outcomes of the brachial plexus lesions caused by gunshot wounds in adults. J Brachial Plex Peripher Nerve Inj. 2009;4:11.

Izci Y, Gurkanlar D, Ozan H, Gonul E. The morphological aspects of lumbar plexus and roots: An anatomical study. Turk Neurosurg. 2005;15:87-92.

Izci Y, Taskaynatan MA. Management of lower back pain in young Turkish recruits. Mil Med. 2004;169:824-8.

Temiz C, Solmaz I, Tehli O, Kaya S, Onguru O, Arslan E, et al. The effects of splenectomy on lipid peroxidation and neuronal loss in experimental spinal cord ischemia/reperfusion injury. Turk Neurosurg. 2013;23:67-74.

Baysefer A, Erdogan E, Kahraman S, Izci Y, Korkmaz C, Solmaz I, et al. Effect of mannitol in experimental spinal cord injury: an ultrastructural and electrophysiological study. Neurol India. 2003;51:350-4.

Baysallar M, Izci Y, Kilic A, Avci IY, Senses Z, Doganci L. A case of ventricular drainage infection with a rare pathogen in cerebrospinal f luid: vancomycin-resistant Enterococcus faecium. Microb Drug Resist. 2006;12:59-62.

Izci Y. Lumbosacral spinal epidural abscess caused by Brucella melitensis. Acta Neurochir (Wien). 2005;147:1207-9.

Secer HI, Kural C, Kaplan M, Kilic A, Duz B, Gonul E, et al. Comparison of the efficacies of antibiotic-impregnated and silver-impregnated ventricular catheters on the prevention of infections. An in vitro laboratory study. Pediatr Neurosurg. 2008;44:444-7.

Ozer H, Akçalı O, Koçak A. Spinal instability following gunshot wounds. Report of two cases. JTSS. 1999;10:19-22.

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