Case records of 88 patients with low-velocity gunshot
injuries of the terminal spinal cord and cauda equina treated by
laminectomy at Cook County Hospital between 1969 and 1987 were reviewed. Sixty-one patients were operated upon within 72 hours of injury, 29 of whom (47.5%) experienced neurological improvement or
pain relief. Twenty-seven patients were operated upon at a later time for associated
injuries, 13 of whom (48.1%) experienced neurological improvement or
pain relief. When
laminectomy was delayed for more than 2 weeks, either arachnoid adhesions (15%) or occult
abscesses (17%) were observed. From this review as well as from the literature, it appears that the timing of
laminectomy for gunshot
injuries of the thoracolumbar and lumbosacral spine is not essential to neurological recovery. It appears, however, that adequate
debridement of these
injuries, performed as soon as the patient is stable from any associated
injuries, may help to mitigate the late sequelae of
arachnoiditis,
infection, and
pain syndromes in the lower extremities.