MANAGEMENT OF RETAINED GUNSHOT INJURIES TO THE SPINE: A SYSTEMATIC LITERATURE REVIEW
ABSTRACT Spinal cord injuries from gunshot wounds are a major concern, ranking as the third leading cause of spinal trauma. Despite its high prevalence in some countries, there is no consensus regarding the surgical treatment of such injuries. This study aims to provide a comprehensive review of the...
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Sociedade Brasileira de Coluna (SBC)
2025-08-01
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| Series: | Coluna/Columna |
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| Online Access: | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1808-18512025000200901&tlng=en |
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| author | EMILIANO NEVES VIALLE JOSE ORLANDO GUINTO NAVA OTáVIO VITóRIO ALVARENGA PEREIRA LUIS FELIPE TOSTES PEREIRA JOãO VICTOR NASCIMENTO FERREIRA VINICIUS LOPES FRUET GUILLERMO ALEJANDRO RICCIARDI |
| author_facet | EMILIANO NEVES VIALLE JOSE ORLANDO GUINTO NAVA OTáVIO VITóRIO ALVARENGA PEREIRA LUIS FELIPE TOSTES PEREIRA JOãO VICTOR NASCIMENTO FERREIRA VINICIUS LOPES FRUET GUILLERMO ALEJANDRO RICCIARDI |
| author_sort | EMILIANO NEVES VIALLE |
| collection | DOAJ |
| description | ABSTRACT Spinal cord injuries from gunshot wounds are a major concern, ranking as the third leading cause of spinal trauma. Despite its high prevalence in some countries, there is no consensus regarding the surgical treatment of such injuries. This study aims to provide a comprehensive review of the management of retained spinal gunshot projectiles. Systematic literature review from 1999 to 2024, following MOOSE, PRISMA, and STROBE guidelines. The research question focused on the indication for the removal of retained projectiles on the spine. We have assessed treatment strategies based on spinal segment, vertebral segment, projectile type, and risk of lead poisoning. Of 331 studies, 30 were included, identifying key variables affecting therapeutic decisions. Management depends on the projectile location and neurological status. Early removal of cervical injuries is advised. Thoracic projectiles may be retained in non-progressive injuries. In the lumbar region, removal is recommended due to the potential for multiple neuronal compressions. Vertebral body projectiles only require removal if they compromise mechanical stability. Projectiles in the intervertebral disc and facet need close monitoring for lead poisoning risks, while those in paravertebral muscles usually remain unless symptoms arise. Copper and fragmented projectiles have a higher complication risk and should also be closely monitored. There is scientific evidence supporting systematized decision-making for managing retained gunshot projectiles. Level of Evidence II; Systematic Review. |
| format | Article |
| id | doaj-art-9ffbb8d94637497c82fa07f8735fb823 |
| institution | Kabale University |
| issn | 2177-014X |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Sociedade Brasileira de Coluna (SBC) |
| record_format | Article |
| series | Coluna/Columna |
| spelling | doaj-art-9ffbb8d94637497c82fa07f8735fb8232025-08-20T03:41:54ZengSociedade Brasileira de Coluna (SBC)Coluna/Columna2177-014X2025-08-0124210.1590/s1808-185120252402293832MANAGEMENT OF RETAINED GUNSHOT INJURIES TO THE SPINE: A SYSTEMATIC LITERATURE REVIEWEMILIANO NEVES VIALLEhttps://orcid.org/0000-0003-1157-4889JOSE ORLANDO GUINTO NAVAhttps://orcid.org/0000-0001-6656-8748OTáVIO VITóRIO ALVARENGA PEREIRAhttps://orcid.org/0000-0003-0339-1310LUIS FELIPE TOSTES PEREIRAhttps://orcid.org/0000-0002-2410-3851JOãO VICTOR NASCIMENTO FERREIRAhttps://orcid.org/0009-0004-2532-8309VINICIUS LOPES FRUEThttps://orcid.org/0009-0007-9583-5359GUILLERMO ALEJANDRO RICCIARDIhttps://orcid.org/0000-0002-6959-9301ABSTRACT Spinal cord injuries from gunshot wounds are a major concern, ranking as the third leading cause of spinal trauma. Despite its high prevalence in some countries, there is no consensus regarding the surgical treatment of such injuries. This study aims to provide a comprehensive review of the management of retained spinal gunshot projectiles. Systematic literature review from 1999 to 2024, following MOOSE, PRISMA, and STROBE guidelines. The research question focused on the indication for the removal of retained projectiles on the spine. We have assessed treatment strategies based on spinal segment, vertebral segment, projectile type, and risk of lead poisoning. Of 331 studies, 30 were included, identifying key variables affecting therapeutic decisions. Management depends on the projectile location and neurological status. Early removal of cervical injuries is advised. Thoracic projectiles may be retained in non-progressive injuries. In the lumbar region, removal is recommended due to the potential for multiple neuronal compressions. Vertebral body projectiles only require removal if they compromise mechanical stability. Projectiles in the intervertebral disc and facet need close monitoring for lead poisoning risks, while those in paravertebral muscles usually remain unless symptoms arise. Copper and fragmented projectiles have a higher complication risk and should also be closely monitored. There is scientific evidence supporting systematized decision-making for managing retained gunshot projectiles. Level of Evidence II; Systematic Review.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1808-18512025000200901&tlng=enWoundsGunshotInjuryEvidence-Based PracticeSpinal CordSpinal Cord InjuriesWounds. |
| spellingShingle | EMILIANO NEVES VIALLE JOSE ORLANDO GUINTO NAVA OTáVIO VITóRIO ALVARENGA PEREIRA LUIS FELIPE TOSTES PEREIRA JOãO VICTOR NASCIMENTO FERREIRA VINICIUS LOPES FRUET GUILLERMO ALEJANDRO RICCIARDI MANAGEMENT OF RETAINED GUNSHOT INJURIES TO THE SPINE: A SYSTEMATIC LITERATURE REVIEW Coluna/Columna Wounds Gunshot Injury Evidence-Based Practice Spinal Cord Spinal Cord Injuries Wounds. |
| title | MANAGEMENT OF RETAINED GUNSHOT INJURIES TO THE SPINE: A SYSTEMATIC LITERATURE REVIEW |
| title_full | MANAGEMENT OF RETAINED GUNSHOT INJURIES TO THE SPINE: A SYSTEMATIC LITERATURE REVIEW |
| title_fullStr | MANAGEMENT OF RETAINED GUNSHOT INJURIES TO THE SPINE: A SYSTEMATIC LITERATURE REVIEW |
| title_full_unstemmed | MANAGEMENT OF RETAINED GUNSHOT INJURIES TO THE SPINE: A SYSTEMATIC LITERATURE REVIEW |
| title_short | MANAGEMENT OF RETAINED GUNSHOT INJURIES TO THE SPINE: A SYSTEMATIC LITERATURE REVIEW |
| title_sort | management of retained gunshot injuries to the spine a systematic literature review |
| topic | Wounds Gunshot Injury Evidence-Based Practice Spinal Cord Spinal Cord Injuries Wounds. |
| url | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1808-18512025000200901&tlng=en |
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