Civilian Ballistic Injuries to the Atlantoaxial Spine: A Single Institution Case Series.
Journal
Clinical spine surgery
ISSN: 2380-0194
Titre abrégé: Clin Spine Surg
Pays: United States
ID NLM: 101675083
Informations de publication
Date de publication:
09 Apr 2024
09 Apr 2024
Historique:
received:
08
12
2023
accepted:
28
02
2024
medline:
19
4
2024
pubmed:
19
4
2024
entrez:
19
4
2024
Statut:
aheadofprint
Résumé
Retrospective case series. Describe the injury characteristics of ballistic fractures involving the atlantoaxial spine. Civilian gunshot wounds to the spine are an increasingly common injury in the United States. Civilian studies have focused on ballistic injuries to the entire spine as opposed to a region-specific fashion. Only a single 10-patient case series investigating ballistic fractures to the upper cervical spine (C1 and C2) exists, leaving a large gap in the understanding of this injury complex. A retrospective chart review was performed. Extracted data included patient demographics, neurological status on presentation, fracture morphology, assessment of stability, other associated injuries, and surgical procedures performed. Proportional analysis was performed to characterize the fractures and their associated neurological injuries. Thirty-six patients were identified, with 86% being male with an average patient age of 30.0 ± 10.36 years (mean ± SD). Fracture morphology was characterized using proportional analysis. Initial neurological exams were either ASIA A or ASIA E, without any incomplete injuries noted. Patients who sustained a transcanal injury did not show any neurological improvement. The initial in-hospital mortality rate was 5.6%, with a 1-year mortality rate of 8.3%. There is a high incidence of associated vascular injury (66%) and mandible fracture (33%). Ballistic penetrating trauma to the atlantoaxial spine often results in complex injury patterns necessitating multidisciplinary care with high rates of morbidity and mortality. If neurological deficits are present initially, they are often complete. Two thirds of patients sustained an associated vascular injury, which should be screened for with CT angiography.
Sections du résumé
STUDY DESIGN
METHODS
Retrospective case series.
OBJECTIVE
OBJECTIVE
Describe the injury characteristics of ballistic fractures involving the atlantoaxial spine.
SUMMARY OF BACKGROUND DATA
BACKGROUND
Civilian gunshot wounds to the spine are an increasingly common injury in the United States. Civilian studies have focused on ballistic injuries to the entire spine as opposed to a region-specific fashion. Only a single 10-patient case series investigating ballistic fractures to the upper cervical spine (C1 and C2) exists, leaving a large gap in the understanding of this injury complex.
METHODS
METHODS
A retrospective chart review was performed. Extracted data included patient demographics, neurological status on presentation, fracture morphology, assessment of stability, other associated injuries, and surgical procedures performed. Proportional analysis was performed to characterize the fractures and their associated neurological injuries.
RESULTS
RESULTS
Thirty-six patients were identified, with 86% being male with an average patient age of 30.0 ± 10.36 years (mean ± SD). Fracture morphology was characterized using proportional analysis. Initial neurological exams were either ASIA A or ASIA E, without any incomplete injuries noted. Patients who sustained a transcanal injury did not show any neurological improvement. The initial in-hospital mortality rate was 5.6%, with a 1-year mortality rate of 8.3%. There is a high incidence of associated vascular injury (66%) and mandible fracture (33%).
CONCLUSIONS
CONCLUSIONS
Ballistic penetrating trauma to the atlantoaxial spine often results in complex injury patterns necessitating multidisciplinary care with high rates of morbidity and mortality. If neurological deficits are present initially, they are often complete. Two thirds of patients sustained an associated vascular injury, which should be screened for with CT angiography.
Identifiants
pubmed: 38637934
doi: 10.1097/BSD.0000000000001627
pii: 01933606-990000000-00291
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
M.J.L. receives consulting fees from Globus Medical. The remaining authors declare no conflict of interest.
Références
Lyons JG. Epidemiology of ballistic fractures in the United States: a 20-year analysis of the Firearm Injury Surveillance Study. Injury. 2022;53:3663–3672.
Aarabi B, Alibaii E, Taghipur M, et al. Comparative study of functional recovery for surgically explored and conservatively managed spinal cord missile injuries. Neurosurgery. 1996;39:1133–1140.
Kahraman S, Gonul E, Kayali H, et al. Retrospective analysis of spinal missile injuries. Neurosurg Rev. 2004;27:42–45.
Guzelkucuk U, Demir Y, Kesikburun S, et al. Spinal cord injury resulting from gunshot wounds: a comparative study with non-gunshot causes. Spinal Cord. 2016;54:737–741.
Bin-Alamer O, Bhenderu LS, Stuebe C, et al. Penetrating spinal cord injury: a systematic review and meta-analysis of clinical features and treatment outcomes. Spinal Cord. 2022;60:845–853.
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;35:323–327.
Kupcha PC, An HS, Cotler JM. Gunshot wounds to the cervical spine. Spine (Phila Pa 1976). 1990;15:1058–1063.
Beaty N, Slavin J, Diaz C, et al. Cervical spine injury from gunshot wounds. J Neurosurg Spine. 2014;21:442–449.
Heiden JS, Weiss MH, Rosenberg AW, et al. Penetrating gunshot wounds of the cervical spine in civilians. Review of 38 cases. J Neurosurg. 1975;42:575–579.
Benton JA, Rahme R, Krystal J, et al. Retained bullet in the cervical spinal canal and the associated surgical management conundrum: case report and review of the literature. Spinal Cord Ser Cases. 2020;6:77.
Benzel EC, Hadden TA, Coleman JE. Civilian gunshot wounds to the spinal cord and cauda equina. Neurosurgery. 1987;20:281–285.
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;40:450–461.
Escamilla JAC, Ross JAG, Atanasio JMP, et al. Spinal gunshot wounds: pattern and associated lesions in civilians. Asian Spine J. 2018;12:648–655.
Ge L, Jubril A, Mesfin A. Civilian gun shot wounds associated with spinal injuries. Global Spine J. 2022;12:1428–1433.
Platt A, Dafrawy MHE, Lee MJ, et al. Gunshot wounds to the lumbosacral spine: systematic review and meta-analysis. Global Spine J. 2022;12:1247–1253.
Robertson DP, Simpson RK. Penetrating injuries restricted to the cauda equina: a retrospective review. Neurosurgery. 1992;31:265–269; discussion 269-270.
Staggers JR, Niemeier TE, Neway WE III, et al. Stability of the subaxial spine after penetrating trauma: do classification systems apply? Adv Orthop. 2018;2018:6085962.
Syre P III, Rodriguez-Cruz L, Desai R, et al. Civilian gunshot wounds to the atlantoaxial spine: a report of 10 cases treated using a multidisciplinary approach. J Neurosurg Spine. 2013;19:759–766.
Baker HP, Straszewski AJ, Dahm JS, et al. Gunshot-related lower extremity nerve injuries. Eur J Orthop Surg Traumatol. 2023;33:851–856.
Portney DA, Baker HP, Stillson QA, et al. Isolated ballistic femoral condyle fractures: a case series of eighteen patients. Eur J Orthop Surg Traumatol. 2023;33:1091–1099.
Baker HP, Krishnan P, Foy M, et al. Effect of nailing technique on length of stay in isolated ballistic femoral shaft fractures. Eur J Orthop Surg Traumatol. 2023;33:353–360.
Schaefer SD, Bucholz RW, Jones RE, et al. The management of transpharyngeal gunshot wounds to the cervical spine. Surg Gynecol Obstet. 1981;152:27–29.
Medzon R, Rothenhaus T, Bono CM, et al. Stability of cervical spine fractures after gunshot wounds to the head and neck. Spine (Phila Pa 1976). 2005;30:2274–2279.
Lustenberger T, Talving P, Lam L, et al. Unstable cervical spine fracture after penetrating neck injury: a rare entity in an analysis of 1,069 patients. J Trauma. 2011;70:870–872.
Paiva WS, Amorim RL, Menendez DF, et al. Gunshot wound to the upper cervical spine leading to instability. Int J Clin Exp Med. 2014;7:789–791.
Velmahos G, Demetriades D. Gunshot wounds of the spine: should retained bullets be removed to prevent infection? Ann R Coll Surg Engl. 1994;76:85–87.