Surgery may improve functional outcomes in patients with thoracic, lumbar gunshot injuries
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Patients with gunshot injuries in the thoracic and lumbar spine had twice the chance of neurologic improvement with surgical intervention compared with nonsurgical care, according to results.
Using the National Spinal Cord Injury Statistical Center database, Brendan Striano, MD, and colleagues identified 961 patients who received either surgical or nonsurgical intervention for a gunshot-induced spinal injury.
“In order to be included, you had to have at least 1 year of follow-up, with clear documentation of what your [American Spinal Injury Association] ASIA Impairment Scale was at presentation and, at 1-year follow-up along with documentation of the region of your injury in terms of where in the spine, also whether or not you were treated with surgical or nonsurgical management,” Striano said in his presentation at the North American Spine Society Annual Meeting.
Striano noted 20% of patients were treated surgically and 80% of patients had nonsurgical treatment. Overall, 52% of patients had a thoracic level injury and about 70% of patients had an ASIA A injury, according to Striano.
“In terms of looking at the comparative analysis, 34% of patients who had surgical intervention had an improvement in their ASIA Impairment Scale at 1 year from their follow-up comparing that to 20% of patients who were treated nonoperatively who had an improvement in their ASIA Impairment Scale at 1-year follow-up,” Striano said.
He added patients had a two times increased likelihood of improvement in the ASIA Impairment Scale with surgical intervention vs. nonoperative treatment.
Among patients who had a cervical injury, Striano noted surgical intervention did not improve ASIA Impairment Scale score at 1-year follow-up. However, he said patients with either a thoracic or lumbar injury had 2.5 times and 1.7 times increased likelihood of improvement in the ASIA Impairment Scale with surgical intervention, respectively.
“The data were then confirmed with a multivariable analysis, wherein the statuses of having undergone surgical treatment and ASIA Impairment Scale at presentation were the only two variables that were statistically significantly associated with the likelihood of having improvement at 1 year’s time,” Striano said.
In an analysis of 680 patients with ASIA A injuries, 21% of patients treated surgically had an improvement in their ASIA Impairment Scale score at follow-up vs. 10% of patients treated nonoperatively, according to Striano.
“Taken together, that is about a 2.2 times increased likelihood of having improvement in your ASIA Impairment Scale if you came in as an ASIA A and were offered surgery as compared to coming in as an ASIA A and being treated nonoperatively,” Striano said.
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Goh B, et al. Paper 256. Presented at: North American Spine Society Annual Meeting. Sept. 29 - Oct. 2, 2021; Boston (hybrid meeting).
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