Surgical Considerations and Neurological Outcomes in Ballistic Penetrating Subaxial Cervical Spine Fractures: A Retrospective Analysis.

Study design: A retrospective analysis.

Objective: To understand this condition and optimize management of patients who suffer from this injury.

Summary of background data: Ballistic penetrating spine injury is the third most common cause of spinal cord injury. Management strategy for penetrating injury is largely guided from data from blunt injury.

Methods: In this study, we present 38 patients who suffered ballistic penetrating injury to the subaxial cervical spine at the University of Chicago Medical Center from April 2018 to July 2022. Data were retrospectively collected.

Results: The average age was 30 years old. A total of 92% were male. A total of 84% were African American. A total of 5% were Caucasian and 11% were others. A total of 95% were male and 5% were female. Patients presented with neurological deficits were more likely to have the following: intracanal air (P=0.004), transcanal trajectory (P=0.018), epidural hematoma (P=0.018), intracanal bone (P=0.000), intracanal metal (P=0.018), laminar fracture (P=0.000), vertebral body fracture (P=0.026), pedicle fracture (P=0.001), facet fracture (P=0.002), and involvement of the C5 level (P=0.026). Four patients had full comminuted vertebral body fracture and all 4 had surgery. Eight patients (16.67%) had spinal surgical intervention: 4 patients out of 7 who had improvement in neurological exam had surgical intervention. Surgical treatment of ballistic cervical spine fractures was not associated with an improvement in neurological exam [OR=4 std 3.83 CI (0.61; 26.12) with P=0.148].

Conclusions: Those with fully comminuted vertebral body fractures, in our experience, are more likely to collapse and be treated surgically. Our data suggests that surgery may have a benefit in improving neurological outcome in ballistic spinal cord injury, which stands in contrast to prior literature. In this population, we strongly consider surgical intervention in patients with active neuro-compressive pathology, structural instability, or severe kyphosis, though each patient must be considered in the context of their overall outlook and health status.