OBJECTIVES: To determine prevalence, mortality and clinical course of patients with gunshot wounds of the spine and determine if the extraction of the bullet improves their neurological status. METHODS: We conducted a case series study by analyzing the medical records of all patients with gunshot wounds in the spine, hospitalized in UMAE, Specialties Hospital of the CMNO, IMSS, from September 2010 to September 2011, which were compatible with the inclusion, exclusion, and not-inclusion criteria. The degree of disability of patients was measured by the Oswestry index. RESULTS: The group consisted of 13 (86.7%) males and 2 (13.3%) females, with a mean age of 42 years and standard deviation of 14 years. The regions most affected were thoracic with 7 (46.7%), cervical with 5 (33.3%) and, finally, lumbar, with 3 (20%) patients; the most frequent hospital stays were 7 (13, 3%) and 10 (13.3%) days with 2 cases each; minimum hospital stay was 3 days, with only one (6.7%) case and the largest was 94 days in one (6.7 %) patient. A stay exceeding 10 days occurred in 11 (73.3%) patients and less than 10 days in 4 (26.7%). Surgical treatment was performed in 4 (26.7%) patients and 11 (73.3%) patients received only medical therapy; the extraction of the bullet was performed in 3 (20%) patients, of whom two had infection. Complications were observed in 14 (93.3%) patients and one (6.7%) did not. Six (40%) patients had infection in comparison with nine (60%) who had not. The neurological status by the initial ASIA scale was predominantly "A" in 7 (46.7%) and the final ASIA scale was predominantly "B" in 6 (40%) cases. Three (20%) patients died and 12 (80%) were alive during the study period. The degree of disability measured by the initial Oswestry index was 18 points minimum and maximum was 94, with a mean of 62 and a standard deviation of 22.2. The final Oswestry index averaged 58 points, with a standard deviation of 23.5. CONCLUSIONS: In our study, we conclude that the injury by firearm in the spine causes a high degree of disability and evolve with high morbidity. It should be added that both the medical and the surgical treatment do not provide substantial improvement in neurological and functional status of the patient. Both are limited to support actions to reduce the possible complications, which ultimately is what will influence the quality and survival of those affected. The extraction of the bullet and the time elapsed since surgery does not change the final functional status of the patient.
Wounds; Gunshot; Spine; Prognosis; Prevalence; Clinical evolution
