Unstable cervical spine injury following gunshot wound to the neck is rare—A retrospective review of 221 patients from a major trauma centre in South Africa

Abstract Background Routine application of cervical spine collar for immobilisation is a common practice but remains controversial in the setting of gunshot wounds (GSW) to the neck. Objectives The aim of this study was to review the incidence of unstable cervical spine injuries (CSI) following GSW to the neck in a high volume, developing world setting. Methods A retrospective study conducted over a 10 year period from December 2012 to December 2022 at a major trauma centre in South Africa (Pietermaritzburg Metropolitan Trauma Service). Results A total of 221 patients with GSW were reviewed. Thirty two patients underwent immediate neck exploration and 189 (86%) patients underwent a computed tomography angiography (CTA). Of the 189 patients who underwent CTA of the neck, CSI was noted in 61 (32%). 13 of the 189 patients (7%) had a spinal cord injury. All 13 of these patients had evidence of neurological deficits documented on presentation. Of the 61 patients with CSI, only one patient had an injury considered to be an unstable CSI (comminuted fracture of C5) and underwent an anterior spinal fusion. For those with no neurological deficits on presentation, none developed neurological deficits during their hospital stay or after discharge. Conclusions CSI in the specific context of GSW to the neck is not rare, but the incidence of unstable CSI is a rare entity. There appears to be minimal benefit from the routine application of cervical collar in this setting, especially for patients presenting without neurological deficit.