Civilian gunshot wounds of the spine

A literature review


  • AH Botha
  • BC Booysen


gunshot, spinal injury, neurology, spinal column, lead


The incidence of gun-related violence continues to rise, although accurate statistics are difficult to obtain. Up to 17% of spinal cord injuries are gunshot related. The recent literature pertains to the management of high velocity/energy gunshot wounds as encountered in war scenarios such as Iraq, Afghanistan, etc. The treatment of civilian gunshot wound injuries to the spine has not been clearly stipulated, and many treatment modalities are adopted from the treatment of war injuries, which is a completely different scenario.

 AIM: To evaluate the available literature pertaining to civilian gunshot wound injuries of the spine and the treatment thereof with regard to the indication for bullet removal, antibiotic prophylaxis, lead poisoning, the use of imaging modalities and fracture stability 

CONCLUSION: Although the literature is often conflicting and published case series are outdated, there is consensus that not all bullets or fragments need to be removed; the majority of fractures are stable; MRI is a safe imaging modality; lead poisoning is extremely rare; and extended antibiotics prophylaxis is not needed The indications for bullet removal is deteriorating neurology, intra-canal bullets between T12 and L4 with incomplete neurology, sepsis and lead poisoning should it occur.