[Scoring system for unstable gunshot and blast-fragmentation wounds to the thoracolumbar spine].

Abstract

Background: According to the authors, up to 9.8% of gunshot wounds to the spine are unstable. The lack of tactical classification complicates decision-making regarding the need for fusion surgery. Thus, a scoring protocol was developed for assessing unstable gunshot wounds to the thoracolumbar spine.

Material and methods: The second phase of the study involved survey of 19 expert surgeons. Participants completed the questionnaires twice with a 2-month interval. The Kappa coefficient was used to determine inter- and intra-expert agreement regarding applicability of classifications, presence of injury and contribution of injury of specific anatomical structure to destabilization. The third stage involves statistical analysis and development of a scoring tactical classification.

Results: Traditional assessment systems for closed spinal injuries have extremely low reproducibility when applied to gunshot wounds. Experts demonstrated the greatest consensus when assessing bilateral fractures of the facet joints (κ=0.553-0.614) or roots of arches (κ=0.683-0.713) and vertebral body destruction involving both endplates (κ=0.556-0.570 - moderate agreement). A scoring tactical surgical classification of unstable gunshot wounds to the thoracolumbar spine was developed.

Conclusion: AUC (0.866 for unstable and 0.888 for stable cases) allows the developed classification to be characterized as an "excellent classifier". Considering 87.9% sensitivity and 72.3% specificity (for unstable cases), we can recommend this method for neurosurgeons and traumatologists to optimize treatment strategies for the wounded.