{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T14:27:50Z","timestamp":1793802470605,"version":"4.6.1"},"reference-count":62,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,24]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>The aim of this study was to characterize patient demographics, injury characteristics, clinical management, and inpatient hospital course of victims of gunshot wounds (GSWs) to the spine to describe a \"natural history\" of disease following this injury.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A retrospective analysis was conducted of patients with GSWs to the spine at a level I trauma center in a major urban center from January 2016 to December 2021. Data on demographics, injury grades\/characteristics, and treatment course were analyzed using descriptive and comparative statistics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Of 237 identified cases, patients were predominantly male (210, 88.6%) with a mean age of 26.3 \u00b1 9 years. The most common injury site was the thoracic spine (36.7%), followed by lumbar (30.0%). Most patients (126, 53.2%) had a neurological deficit. A significant number of patients had either bullet fragments (34, 14.3%) or bone fragments (31, 13.1%) in the canal on imaging. Nonoperative management was the primary treatment strategy, with only 2 patients requiring decompressive spinal surgery; no patient underwent fusion. Conventional mean arterial pressure (MAP) goals were maintained in 60 patients (25.3%) for a mean of 5.04 \u00b1 1.86 days, and 4 patients (1.7%) received prophylactic antibiotics for spinal injury. Patients with neurological deficits were more likely to have a neurosurgical consultation and were significantly more likely to have MAP goals as part of their management (p &lt; 0.001). The mean hospital length of stay was 11.5 \u00b1 11.4 days with a mean follow-up time of 7.85 \u00b1 14.74 months, suggesting a minimum postinjury survival period. Most patients were discharged home (141, 59.5%) with a mean modified Rankin Scale score of 2.6 \u00b1 1.8.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>This study represents the largest continuous series of GSWs to the spine in contemporary literature, suggesting a natural history of survivorship and disability in this patient population and characterizing common treatment paradigms at a major urban trauma center.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.6.spine25421","type":"journal-article","created":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T20:53:13Z","timestamp":1763412793000},"page":"300-306","source":"Crossref","is-referenced-by-count":2,"title":["A natural history of penetrating ballistic spinal column injury: a single-center continuous case series"],"prefix":"10.3171","volume":"44","author":[{"given":"Ricky M.","family":"Ditzel","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, Rush University Medical Center; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John Paul G.","family":"Kolcun","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Rush University Medical Center; and"},{"name":"Division of Neurosurgery, John Stroger Hospital of Cook County, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucinda","family":"Chiu","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Rush University Medical Center; and"},{"name":"Division of Neurosurgery, John Stroger Hospital of Cook County, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P. B.","family":"Raksin","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Rush University Medical Center; and"},{"name":"Division of Neurosurgery, John Stroger Hospital of Cook County, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James E.","family":"Towner","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, John Stroger Hospital of Cook County, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"9-10","key":"b1","series-title":"J Neurotrauma","first-page":"1112","article-title":"Epidemiology of gunshot-related spinal injuries and related risk factors for in-hospital mortality in the United States from 2015-2019: a National Trauma Data Bank analysis","volume":"41","author":"Sherrod BA","year":"2024","unstructured":"Sherrod BA, Young JB, Wilkerson CG, Bisson EF, Dailey AT, Mazur MD. Epidemiology of gunshot-related spinal injuries and related risk factors for in-hospital mortality in the United States from 2015-2019: a National Trauma Data Bank analysis. J Neurotrauma. 2024;41(9-10):1112\u20131121."},{"issue":"4","key":"b2","series-title":"Rev Esp Cir Ortop Traumatol","first-page":"328","article-title":"Spinal gunshot wounds: a retrospective, multicenter, cohort study","volume":"68","author":"Ricciardi G","year":"2024","unstructured":"Ricciardi G, Martinez O, Cabrera J,  Spinal gunshot wounds: a retrospective, multicenter, cohort study. Rev Esp Cir Ortop Traumatol. 2024;68(4):328\u2013335."},{"key":"b3","article-title":"Best Practices Guidelines: Spine Injury","year":"2022","unstructured":"Best Practices Guidelines: Spine Injury. American College of Surgeons;2022.Accessed July 11, 2025. https:\/\/www.facs.org\/media\/k45gikqv\/spine_injury_guidelines.pdf"},{"issue":"7","key":"b4","series-title":"Spine (Phila Pa 1976).","first-page":"450","article-title":"An update on civilian spinal gunshot wounds: treatment, neurological recovery, and complications","volume":"40","author":"Bumpass DB","year":"2015","unstructured":"Bumpass DB, Buchowski JM, Park A,  An update on civilian spinal gunshot wounds: treatment, neurological recovery, and complications. Spine (Phila Pa 1976).2015;40(7):450\u2013461."},{"issue":"5","key":"b5","series-title":"Neurosurg Focus","first-page":"E4","article-title":"Can surgery improve neurological function in penetrating spinal injury? A review of the military and civilian literature and treatment recommendations for military neurosurgeons","volume":"28","author":"Klimo P Jr","year":"2010","unstructured":"Klimo P Jr, Ragel BT, Rosner M, Gluf W, McCafferty R. Can surgery improve neurological function in penetrating spinal injury? A review of the military and civilian literature and treatment recommendations for military neurosurgeons. Neurosurg Focus. 2010;28(5):E4."},{"issue":"2","key":"b6","series-title":"Spine (Phila Pa 1976).","first-page":"E117","article-title":"Surgical management of civilian gunshot-induced spinal cord injury: is it overutilized?","volume":"42","author":"Nwosu K","year":"2017","unstructured":"Nwosu K, Eftekhary N, McCoy E, Bhalla A, Fukunaga D, Rolfe K. Surgical management of civilian gunshot-induced spinal cord injury: is it overutilized? Spine (Phila Pa 1976).2017;42(2):E117\u2013E124."},{"key":"b7","series-title":"Front Cardiovasc Med","first-page":"1153432","article-title":"Incidence and risk factors of deep vein thrombosis in patients with spinal cord injury: a systematic review with meta-analysis","volume":"10","author":"Shang Z","year":"2023","unstructured":"Shang Z, Wanyan P, Zhang B, Wang M, Wang X. Incidence and risk factors of deep vein thrombosis in patients with spinal cord injury: a systematic review with meta-analysis. Front Cardiovasc Med. 2023;10:1153432."},{"issue":"1","key":"b8","series-title":"Wound Repair Regen","first-page":"6","article-title":"WHS guidelines for the treatment of pressure ulcers-2023 update","volume":"32","author":"Gould LJ","year":"2024","unstructured":"Gould LJ, Alderden J, Aslam R,  WHS guidelines for the treatment of pressure ulcers-2023 update. Wound Repair Regen. 2024;32(1):6\u201333."},{"issue":"1","key":"b9","series-title":"World J Orthop","first-page":"8","article-title":"Rehabilitation of spinal cord injuries","volume":"6","author":"Nas K","year":"2015","unstructured":"Nas K, Yazmalar L, \u015eah V, Ayd\u0131n A, \u00d6ne\u015f K. Rehabilitation of spinal cord injuries. World J Orthop. 2015;6(1):8\u201316."},{"issue":"10","key":"b10","series-title":"Spinal Cord","first-page":"845","article-title":"Penetrating spinal cord injury: a systematic review and meta-analysis of clinical features and treatment outcomes","volume":"60","author":"Bin-Alamer O","year":"2022","unstructured":"Bin-Alamer O, Bhenderu LS, Stuebe C,  Penetrating spinal cord injury: a systematic review and meta-analysis of clinical features and treatment outcomes. Spinal Cord. 2022;60(10):845\u2013853."},{"issue":"6","key":"b11","series-title":"Global Spine J","first-page":"1247","article-title":"Gunshot wounds to the lumbosacral spine: systematic review and meta-analysis","volume":"12","author":"Platt A","year":"2022","unstructured":"Platt A, Dafrawy MHE, Lee MJ, Herman MH, Ramos E. Gunshot wounds to the lumbosacral spine: systematic review and meta-analysis. 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J Trauma. 2006;60(4):814\u2013820."},{"issue":"3","key":"b25","series-title":"J Spine Surg","first-page":"606","article-title":"Duration of antibiotics for penetrating spine trauma: a systematic review","volume":"6","author":"Mahmood B","year":"2020","unstructured":"Mahmood B, Weisberg M, Baribeau Y, Buehring W, Razi A, Saleh A. Duration of antibiotics for penetrating spine trauma: a systematic review. J Spine Surg. 2020;6(3):606\u2013612."},{"key":"b26","series-title":"Surg Neurol Int","first-page":"327","article-title":"Cerebrospinal fluid leak following penetrating trauma to the spine without neurological deficit: a case report","volume":"13","author":"Ramirez-Ferrer E","year":"2022","unstructured":"Ramirez-Ferrer E, Abaunza-Camacho JF, Pineda-Martinez AF, Aguilera-Pena MP, Riveros-Castillo WM, Laverde-Frade L. Cerebrospinal fluid leak following penetrating trauma to the spine without neurological deficit: a case report. Surg Neurol Int. 2022;13:327."},{"issue":"12","key":"b27","series-title":"J Surg Case Rep","first-page":"rjaa484","article-title":"Management of cerebrospinal fluid leak from cervical gunshot wounds with external ventricular drainage: a small case series","volume":"2020","author":"Crutcher CL","year":"2020","unstructured":"Crutcher CL, Wilson JM, Morrow KD,  Management of cerebrospinal fluid leak from cervical gunshot wounds with external ventricular drainage: a small case series. J Surg Case Rep. 2020;2020(12):rjaa484."},{"issue":"2","key":"b28","series-title":"Korean J Neurotrauma","first-page":"63","article-title":"Traumatic cerebrospinal fluid leak: diagnosis and management","volume":"13","author":"Oh JW","year":"2017","unstructured":"Oh JW, Kim SH, Whang K. Traumatic cerebrospinal fluid leak: diagnosis and management. Korean J Neurotrauma. 2017;13(2):63\u201367."},{"key":"b29","series-title":"In: StatPearls. 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Can surgery improve neurological function in penetrating spinal injury? A review of the military and civilian literature and treatment recommendations for military neurosurgeons. Neurosurg Focus. 2010;28(5):E4."},{"issue":"2","key":"b6","series-title":"Spine (Phila Pa 1976).","first-page":"E117","article-title":"Surgical management of civilian gunshot-induced spinal cord injury: is it overutilized?","volume":"42","author":"Nwosu K","year":"2017","unstructured":"Nwosu K, Eftekhary N, McCoy E, Bhalla A, Fukunaga D, Rolfe K. Surgical management of civilian gunshot-induced spinal cord injury: is it overutilized? Spine (Phila Pa 1976).2017;42(2):E117\u2013E124."},{"key":"b7","series-title":"Front Cardiovasc Med","first-page":"1153432","article-title":"Incidence and risk factors of deep vein thrombosis in patients with spinal cord injury: a systematic review with meta-analysis","volume":"10","author":"Shang Z","year":"2023","unstructured":"Shang Z, Wanyan P, Zhang B, Wang M, Wang X. Incidence and risk factors of deep vein thrombosis in patients with spinal cord injury: a systematic review with meta-analysis. Front Cardiovasc Med. 2023;10:1153432."},{"issue":"1","key":"b8","series-title":"Wound Repair Regen","first-page":"6","article-title":"WHS guidelines for the treatment of pressure ulcers-2023 update","volume":"32","author":"Gould LJ","year":"2024","unstructured":"Gould LJ, Alderden J, Aslam R,  WHS guidelines for the treatment of pressure ulcers-2023 update. Wound Repair Regen. 2024;32(1):6\u201333."},{"issue":"1","key":"b9","series-title":"World J Orthop","first-page":"8","article-title":"Rehabilitation of spinal cord injuries","volume":"6","author":"Nas K","year":"2015","unstructured":"Nas K, Yazmalar L, \u015eah V, Ayd\u0131n A, \u00d6ne\u015f K. Rehabilitation of spinal cord injuries. World J Orthop. 2015;6(1):8\u201316."},{"issue":"10","key":"b10","series-title":"Spinal Cord","first-page":"845","article-title":"Penetrating spinal cord injury: a systematic review and meta-analysis of clinical features and treatment outcomes","volume":"60","author":"Bin-Alamer O","year":"2022","unstructured":"Bin-Alamer O, Bhenderu LS, Stuebe C,  Penetrating spinal cord injury: a systematic review and meta-analysis of clinical features and treatment outcomes. Spinal Cord. 2022;60(10):845\u2013853."},{"issue":"6","key":"b11","series-title":"Global Spine J","first-page":"1247","article-title":"Gunshot wounds to the lumbosacral spine: systematic review and meta-analysis","volume":"12","author":"Platt A","year":"2022","unstructured":"Platt A, Dafrawy MHE, Lee MJ, Herman MH, Ramos E. Gunshot wounds to the lumbosacral spine: systematic review and meta-analysis. 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