Spinal Cord Injury

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Spinal cord gunshot wounds are more common than you think and more devastating than you can imagine. What can we learn from victims?

 

Hollywood depictions of gun violence would have you believe that gunshot wounds result in either instantaneous death or mere “flesh wounds.” The reality is much more nuanced, as gunshot wound survivors comprise a spectrum that range from complete recovery to profound disability. Many will face lengthy hospital stays, multiple medical complications and financial burdens that often go unnoticed after the initial spotlight on the tragic shooting fades away.

Consider the devastating example of spinal cord injuries from firearms. Spinal cord injuries caused by firearms were once overwhelmingly caused by battlefield combat or motor vehicle accidents. However, spinal cord injuries caused by domestic gun violence now account for up to 17% all spinal cord injuries. [1] Survivors of gunshot injuries to the spinal cord are more likely to be young, socioeconomically disadvantaged, and unemployed. [2] These factors contribute to significant challenges to recovery that these survivors will face.

Less than 1% of Americans that survive gunshot wounds to the spinal cord, will leave the hospital without permanent neurological damage. [1] The spinal cord conducts all nerves traveling from the brain to the rest of the body and allows our limbs to move, feel, and interact with the world. The spinal level that the bullet enters correlates with the disability the victim will face. [3] An injury to the lower spine may paralyze the victim’s legs requiring the use of a wheelchair. Victims of upper spine injuries may be permanently reliant on a machine to breathe for them. [4] Some of the additional injuries seen in victims of spinal cord gunshot wounds include:

  • Perforation of the chest wall causing a victim’s lung to fill with blood, known as hemothorax
  • Injuries to the carotid arteries in the neck causing massive blood loss
  • Perforation of the stomach and intestines causing spillage of gastrointestinal contents [5]

As their lives go on, gunshot victims with spinal cord injury still face many medical complications including frequent and chronic urinary tract infections, issues with the function of their bowel and bladder, intractable and excruciating nerve pain, and skin infections. The majority of victims suffer from depression as a result of their condition. The most common lethal complications these survivors face are blood clots in their lungs.

Apart from the pain and suffering endured by these patients, a staggering financial burden exists for them. According to the National Spinal Cord Injury Statistical Center, the cost of caring for a quadriplegic victim (paralysis of arms and legs) is over $1 million during the first year and $185,000 each additional year of life. [1] Worsening the burden is the fact that victims are often unable to ever return to work.

Ultimately, spinal cord gunshot wounds are devastating injuries with profound medical, psychosocial and financial effects that forever affect the survivor. These injuries disproportionately affect members of society with the greatest number of obstacles to recovery. Understanding the forces that result in these injuries is the first step in reducing their incidence.  

 

What you need to know

  • Gunshot wounds to the spinal cord are devastating injuries with high rates of medical complications that are largely preventable
  • Spinal cord injuries resulting from gun violence are costly injuries and, sadly, occur overwhelmingly in people with the least access to resources
  • The percentage of spinal cord injuries due to gun violence has increased with no current mechanism in place to curb its rise

 

Why we need more research

  • The true number of people that suffer gunshot wounds to the spinal cord is unknown and reliable statistics are important
  • Factors affecting the likelihood of sustaining a spinal cord injury (victim demographics, bullet caliber, magazine size, firearm type) are unclear; without knowing this information, we can’t effectively prevent or treat these injuries.

 

References

  1. National Spinal Cord Injury Statistical Center, Facts and Figures at a Glance. Birmingham, AL: University of Alabama at Birmingham, 2017.
  2. De Barros Filho, TEP, Cristante, AF, Marcon, RM, Ono, A & Bilhar, R. Spinal Cord (2014), 52, 504–510.
  3. Waters RL, Sie IH. Clinical Orthopaedics and Related Research. 2003; (408):120-5.
  4. Smith, W; Simmonds, J.O.; Alam, Z.S.; and Grant, R.E., Clinical Orthopaedics and Related Research. 2003; (408) 145–151.
  5. McKinley, W.O., Johns, J.S. & Musgrove, J.J. American Journal of Physical Medicine & Rehabilitation. 1999; 78(2), 102-107.
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