1244 - The Impact of Gun-Violence: Understanding Surgical Intervention for Spinal Cord Injury from Gunshot Wounds

Objectives: To understand the timing of, indications for, and outcomes after spinal surgery in patients with GSW-SCI.

Design: Retrospective Cohort Study



Methods: Patients with traumatic SCI from July 2012-July 2022 (n=1569) were identified from our level 1 trauma center Trauma Registry. Data was obtained from the trauma registry and chart review.

Results: Patients with GSW-SCI were less likely to undergo surgery compared to other etiologies (24.3% vs. 70.2%, p< 0.0001). Time to surgery for GSW-SCI was longer than for other etiologies (49.2±92.9 vs. 30.6 hours±46.0, p=0.012). The most common reason for increased time to surgery was other emergent surgeries (52%). The most common indications for surgery were retained bullet within canal (20%, n=5), unstable spine (20%), retained bullet and unstable spine (24%), and incomplete injury (12%).

Of 103 patients with GSW-SCI, 25 underwent surgical spine interventions while 78 did not. The operative and non-operative groups were similar in gender, age, and race/ethnicity. Neurologic level of injury at initial exam was thoracic (50%), cervical (29.1%), and lumbar (13.6%). Cervical injuries underwent surgery more often than thoracolumbar injuries (36.7% vs. 22.6%). A higher percentage of patients treated conservatively were discharged from inpatient rehabilitation with improved ASIA grade (20.5% vs. 12.0%).

Conclusions: Surgery was delayed in patients with GSW-SCI compared to other etiologies with average time to surgery >48 hours and variability in timing, indication, and group characteristics. Surgical care details should be considered in the interpretation of surgical outcomes after GSW-SCI.