Gunshot injuries to the spine

" Consider the injury level (cervical, lumbar, thoracic), spinal stability (substantial vertebral body collapse, facet disruption, and so forth), and neurological status (progressive neurological deficits) as well as highenergy compared with low-energy ballistic pattern (high energy is often associated with large, soft-tissue injury) when deciding between operative treatment and nonoperative treatment of gunshot injuries to the spine. " The use of corticosteroid treatment for neurological injury resulting from a gunshot wound to the spine is not currently recommended given the risk of complications and the lack of evidence showing benefit. " Antibiotic prophylaxis of gunshot injuries to the spine should include empiric treatment to cover skin flora for three days (for example, cefazolin, 2 g intravenously every eight hours, or equivalent). For injuries that first transverse the gastrointestinal tract, antibiotics that cover both skin and bowel flora are traditionally recommended for at least seven days (ampicillin and sulbactam, piperacillin and tazobactam, or clindamycin), although a shorter regimen may be sufficient. " When gunshot injuries to the spine involve retained bullet fragments, clinical surveillance should be considered to avoid lead toxicity. Clinicians should be familiar with the common clinical signs and should obtain serum lead levels when present. Treatment with chelation therapy and/or surgical removal of retained fragments may be necessary. " Magnetic resonance imaging (MRI) in the presence of retained bullet fragments near the spine may be safe in the case of bullets with a lead core and copper or alloy jacket, but not for bullets made of steel.