背景：脊柱枪伤（GSWs）是美国发病率和死亡率的重要原因，约占所有脊柱损伤的20%。这些伤害的管理是一个研究不足和有争议的话题，鉴于其异质性和缺乏后续数据。
目的：对脊柱GSW的管理和随访进行表征。
方法：对两个城市一级创伤中心的经验进行多机构回顾性审查。
方法：2010-2021年间患有脊柱GSW的患者。
方法：措施包括工作状态，后续医疗保健利用，并收集疼痛管理。
方法：对人口统计学图表进行了综述，损伤特征,手术和医疗管理，和后续行动。统计分析包括用于比较连续变量的T检验和ANOVA以及用于分类变量的卡方检验。所有统计数据均在SPSSv24上进行(IBM，Armonk,NY).
结果：271例患者被纳入分析。平均年龄28岁,82.7%的患者是黑人,90%是男性,76.4%有医疗保险/医疗补助。胸椎（35％）最常见，其次是腰椎（33.9％）和颈椎（25.6％）。宫颈GSW与较高的死亡率相关(p<0.001);8.7%的患者随后发展为骨髓炎/椎间盘炎,71.3%接受预防性抗生素治疗，56.1%的宫颈GSW有椎动脉或颈动脉损伤。陈述时的ASIA分数最常见的是A（26.9%），D（20.7%），或E（19.6%），其次是C(7.4%)和B(6.6%)。18.8%的患者在就诊时无法进行评估。仅有2例患者ASIA评分下降,而15.5%的人在住院期间有所改善。那些改善的人更有可能发生ASIAB损伤(p<0.001)。总的来说,9.2%的患者接受了脊柱手术。其中,33%表示为ASIAA，21%为ASIAB，29%为ASIAC，13%为ASIAD。手术与ASIA评分的改善无关。
结论：鉴于GSW对脊柱的普遍存在和异质体验，应严格尝试定义该人群及其临床和手术结局.这里,我们对两个大型创伤中心就诊的11年患者进行了分析，以阐明就诊模式，管理,和后续行动。我们强调，颈椎GSW最常见于年轻的黑人男性患者。它们与高死亡率和高椎动脉损伤率相关，并且手术干预不会改变椎间盘炎/骨髓炎的发生率或神经系统恢复的倾向；此外，在研究人群中没有延迟性脊柱不稳定的发生率.
BACKGROUND: Gunshot wounds (GSWs) to the vertebral column represent an important cause of morbidity and mortality in the United States, constituting approximately 20% of all spinal injuries. The management of these injuries is an understudied and controversial topic, given its heterogeneity and lack of follow-up data.
OBJECTIVE: To characterize the management and follow-up of GSWs to the spine.
METHODS: A multi-institutional retrospective review of the experience of two urban Level 1 trauma centers.
METHODS: Patients with GSWs to the spine between 2010-2021.
METHODS: Measures included work status, follow-up healthcare utilization, and pain management were collected.
METHODS: Charts were reviewed for demographics, injury characteristics, surgery and medical management, and follow-up. Statistical analysis included T-tests and ANOVA for comparisons of continuous variables and chi-square testing for categorical variables. All statistics were performed on SPSS v24 (IBM, Armonk, NY).
RESULTS: A total of 271 patients were included for analysis. The average age was 28 years old, 82.7% of patients were black, 90% were male, and 76.4% had Medicare/Medicaid. The thoracic spine (35%) was most commonly injured followed by lumbar (33.9%) and cervical (25.6%). Cervical GSW was associated with higher mortality (p<.001); 8.7% of patients developed subsequent osteomyelitis/discitis, 71.3% received prophylactic antibiotics, and 56.1% of cervical GSW had a confirmed vertebral or carotid artery injury. ASIA scores at presentation were most commonly A (26.9%), D (20.7%), or E (19.6%), followed by C (7.4%) and B (6.6%). 18.8% of patients were unable to be assessed at presentation. ASIA score declined in only 2 patients, while 15.5% improved over their hospital stay. Those who improved were more likely to have ASIA B injury (p<.001). Overall, 9.2% of patients underwent spinal surgery. Of these, 33% presented as ASIA A, 21% as ASIA B, 29% as ASIA C, and 13% as ASIA D. Surgery was not associated with an improvement in ASIA score.
CONCLUSIONS: Given the ubiquitous and heterogeneous experience with GSWs to the spine, rigorous attempts should be made to define this population and its clinical and surgical outcomes. Here, we present an analysis of 11 years of patients presenting to two large trauma centers to elucidate patterns in presentation, management, and follow-up. We highlight that GSWs to the cervical spine are most often seen in young black male patients. They were associated with high mortality and high rates of injury to vertebral arteries and that surgical intervention did not alter rates of discitis/osteomyelitis or propensity for neurologic recovery; moreover, there was no incidence of delayed spinal instability in the study population.
