Characteristics of thoracolumbar spinal cord injuries caused by gunshot wounds

Ramón Quintanilla-Loredo, Department of Orthopedics and Traumatology, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León. Monterrey, Nuevo León, Mexico
Óscar A. Martínez-Gutiérrez, Department of Orthopedics and Traumatology, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León. Monterrey, Nuevo León, Mexico
Pedro M. Reyes-Fernández, Department of Orthopedics and Traumatology, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León. Monterrey, Nuevo León, Mexico
Héctor N.G. Silva-Ramos, Department of Orthopedics and Traumatology, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León. Monterrey, Nuevo León, Mexico
Alan G. Martínez-Castro, Department of Orthopedics and Traumatology, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León. Monterrey, Nuevo León, Mexico
Óscar A. Limón-García, Department of Orthopedics and Traumatology, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León. Monterrey, Nuevo León, Mexico
Luis A. Mata-Cruz, Faculty of Medicine, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León. Monterrey, Nuevo León, Mexico
Víctor M. Peña-Martínez, Servicio de Ortopedia y Traumatología, Hospital Universitario “Dr. José Eleuterio González”, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, Mexico

Background: Gunshot wounds (GSWs) to the spine represent a growing public health problem in Mexico, closely linked to increasing violence. These injuries account for up to 20% of spinal cord injuries requiring hospitalization. Their clinical behavior depends on the projectile’s velocity, anatomical location, and associated damage. Objective: To describe the demographic, clinical, epidemiological, and radiological characteristics of spinal gunshot wounds treated at a tertiary hospital in northeastern Mexico. Methods: An ambispective, observational, and descriptive study was conducted including patients with thoracolumbar spinal GSWs treated between January 2015 and January 2025. Demographic, clinical, and radiological variables were collected. Neurological status was assessed using the ASIA classification. Descriptive statistics were performed. Results: A total of 200 patients were included, with a mean age of 30.85 years; 95% were male, and 99.5% belonged to a low socioeconomic level. The thoracic spine was the most frequently affected level (53.5%), followed by lumbar (38%) and sacral (8.5%). Neurological impairment occurred in 55% of cases. The most common entry site was the dorsal region (49%), and 37.5% of patients had no exit wound. Spinous processes were the most commonly affected structures. Conservative treatment was performed in 99% of cases, and the mortality rate was 3%. Conclusions: Spinal GSWs predominantly affect young males of low socioeconomic status, with the thoracic spine being the most common site of injury. Conservative management remains the mainstay of treatment. Mortality was lower than previously reported, reflecting effective protocols at our center.

Keywords: Spine. Gunshot wounds. Spinal cord injury. Epidemiology. Thoracolumbar.