Management of Retained Gunshot Injuries to the Spine: A Systematic Literature Review

Spinal cord injuries from gunshot wounds are a major concern, ranking as the third leading cause of spinal trauma. Despite its high prevalence in some countries, there is no consensus regarding the surgical treatment of such injuries. This study aims to provide a comprehensive review of the management of retained spinal gunshot projectiles. Systematic literature review from 1999 to 2024, following MOOSE, PRISMA, and STROBE guidelines. The research question focused on the indication for the removal of retained projectiles on the spine. We have assessed treatment strategies based on spinal segment, vertebral segment, projectile type, and risk of lead poisoning. Of 331 studies, 30 were included, identifying key variables affecting therapeutic decisions. Management depends on the projectile location and neurological status. Early removal of cervical injuries is advised. Thoracic projectiles may be retained in non-progressive injuries. In the lumbar region, removal is recommended due to the potential for multiple neuronal compressions. Vertebral body projectiles only require removal if they compromise mechanical stability. Projectiles in the intervertebral disc and facet need close monitoring for lead poisoning risks, while those in paravertebral muscles usually remain unless symptoms arise. Copper and fragmented projectiles have a higher complication risk and should also be closely monitored. There is scientific evidence supporting systematized decision-making for managing retained gunshot projectiles. Level of Evidence II; Systematic Review.