{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T02:33:48Z","timestamp":1792290828130,"version":"4.4.0"},"reference-count":21,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Retrospective observational study of patients with spinal cord injuries (SCI) caused by civilian gunshot wounds (GSW) surgically treated at a tertiary hospital between 2017 and 2024.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>The purpose of the study was to evaluate surgical indications, techniques, complications, and neurological outcomes in CGWSCI and assess the role of surgery in this setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Overview of Literature:<\/jats:title>\n                    <jats:p>Gunshot injuries represent up to 17% of spinal cord trauma, mainly affecting young men. Civilian lesions differ from military due to reduced projectile velocity and cavitation effects. Literature shows that prognosis depends primarily on initial American Spinal Injury Association Impairment (ASIA) grade, while the neurological benefit of surgery remains controversial and potentially overestimated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>\n                      Medical records of 24 patients were reviewed. Data included demographics, level of injury, projectile location, neurological status (ASIA scale), surgical procedure, intraoperative cerebrospinal fluid (CSF) leak, repair technique, complications, and neurological outcome. Statistical analysis employed Fisher\u2019s exact and Mann\u2013Whitney tests, with significance at\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.05.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Patients were mostly male (87.5%), mean age 29.7 years. Thoracic lesions predominated (58.3%). Projectiles were intracanal in 50% and fragments in 33.3%. At admission, 70.8% were ASIA A, and 29.2% had incomplete deficits. Neurological improvement occurred in 16.7%, exclusively in incomplete injuries, with a significant association between initial ASIA and recovery (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.003). Injury level, projectile location, and surgical type showed no prognostic correlation. Laminectomy was the most frequent (62.5%). CSF leaks were found intraoperatively in 79.2%, repaired with grafts or primary closure; the repair technique was not associated with recurrence. Complications were rare (8.3%), with one infection and one persistent CSF leak requiring reoperation. Mean follow-up was 348 days.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>CGWSCI predominantly affect young men and often results in complete deficits, with limited potential for neurological recovery. Surgery did not benefit ASIA A patients but may aid selected cases with incomplete deficits, neural compression, instability, or CSF fistula. Initial ASIA grade remains the strongest prognostic factor.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/jcvjs.jcvjs_217_25","type":"journal-article","created":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T15:02:29Z","timestamp":1768489349000},"page":"78-83","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Surgical management of gunshot-induced spinal cord injuries: A case series analysis"],"prefix":"10.4103","volume":"17","author":[{"given":"Paulo Antonio Ribeiro De","family":"Freitas","sequence":"first","affiliation":[{"name":"Division of Neurosurgery, University of S\u00e3o Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raphael Guedes","family":"Povoa","sequence":"additional","affiliation":[{"name":"Faculty of Medicine of the University of S\u00e3o Paulo, University of S\u00e3o Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodrigo Kei","family":"Kuromoto","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, University of S\u00e3o Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roger Schmidt","family":"Brock","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, University of S\u00e3o Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brasil Chian Ping","family":"Jeng","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, University of S\u00e3o Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos Gilberto Carlotti","family":"J\u00fanior","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, University of S\u00e3o Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wellingson Silva","family":"Paiva","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, University of S\u00e3o Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,1,15]]},"reference":[{"key":"R1-20260420","doi-asserted-by":"crossref","first-page":"3945","DOI":"10.1007\/s11999-013-2901-2","article-title":"Civilian gunshot injuries of the spinal cord: A systematic review of the current literature","volume":"471","author":"Sidhu","year":"2013","journal-title":"Clin Orthop Relat Res"},{"key":"R2-20260420","doi-asserted-by":"crossref","first-page":"1428","DOI":"10.1177\/2192568221991802","article-title":"Civilian gun shot wounds associated with spinal injuries","volume":"12","author":"Ge","year":"2022","journal-title":"Global Spine J"},{"key":"R3-20260420","first-page":"328","article-title":"Spinal gunshot wounds: A retrospective, multicenter, cohort study","volume":"68","author":"Ricciardi","year":"2024","journal-title":"Rev Esp Cir Ortop Traumatol"},{"key":"R4-20260420","first-page":"379","article-title":"Spinal cord injury. 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