EVALUATION OF OUTCOME OF PENETRATING SPINE INJURY, TERTIARY CARE CENTER

Abstract

Penetrating spine injuries are second most common spine injury after blunt trauma. Stab wounds and, gunshot wounds are two common types of penetrating injuries. Surgery has a signicant role in penetrating spine injury in cases of cord transection, cord compression by foreign body/ bony and soft tissue fragment, bony instability and in CSF leak. Stab wounds have comparatively better prognosis. Moreover, surgery plays a much larger role. Retained foreign objects should be removed after a stab injury, whereas bullet fragments may be left in place if it is not causing any role in neurological compression. Penetrating spine injuries are the second leading cause of spinal cord injuries. There is high rate of complications in surgical intervention for penetrating spine injuries to the spine. Very few literatures are available showing data on Penetrating spine injuries to the spine in India. Approximately 38 cases over the last 3 years have been recorded, with unusual presentation and neurological recovery. We tried to ll this gap in data, by reviewing cases of Penetrating spine injuries to spine presenting at a tertiary care hospital. A Retrospective cohort Methods study, in which Patients of all ages who presented to the emergency department of IMS BHU, with Penetrating spine injuries between October 2019 and April 2022 were included in the study. Neurological examinations were done and data were collected. American Spinal Injury Association score (ASIA) was used for the initial and follow-up neurological assessment. Extent of cord transection, motor and sensory decits were also recorded. The patients were grouped into patients with cord transaction and those with cord contusion with cord compression by foreign body or by bony and soft tissue fragment, CSF leak, and intact spinal cord and having fractures with bony instability. All patients were then followed and the outcomes were recorded. A total of 38 patients were identied. The mean ± Results SD of patients age was (30.9 ± 9.5) years. Of the 38patients with Penetrating spine injuries 36 were gunshot wounds, 2 had sharp weapon penetrating spinal cord injury.35 patients were managed surgically and conservative management done in 3 patients. The mean ± SD of follow-up was (8.7 ± 7.2) months. In our study, dorsal spine was the most commonly injured region. Of the 38 patients with medical imaging performed at our institute, 27 (71.05%) having cord contusion, 6(15.78%) were having cord compression by foreign body, 3(7.89%) were having bony instability without cord contusion and 2(5.26%) having CSF leak. Conclusion The prognosis of Penetrating spine injuries to the spine depends on whether the spinal cord is intact or transected and on presence of bony instability. Above inference will help healthcare providers to plan the further management of the patient and counsel them accordingly.