Scoring system for unstable gunshot and blast-fragmentation wounds to the thoracolumbar spine

Background. According to the authors, up to 9.8% of gunshot wounds to the spine are unstable. The lack of tactical classification complicates decision-making regarding the need for fusion surgery. Thus, a scoring protocol was developed for assessing unstable gunshot wounds to the thoracolumbar spine. Material and methods. The second phase of the study involved survey of 19 expert surgeons. Participants completed the questionnaires twice with a 2-month interval. The Kappa coefficient was used to determine inter- and intra-expert agreement regarding applicability of classifications, presence of injury and contribution of injury of specific anatomical structure to destabilization. The third stage involves statistical analysis and development of a scoring tactical classification. Results. Traditional assessment systems for closed spinal injuries have extremely low reproducibility when applied to gunshot wounds. Experts demonstrated the greatest consensus when assessing bilateral fractures of the facet joints (κ=0.553—0.614) or roots of arches (κ=0.683—0.713) and vertebral body destruction involving both endplates (κ=0.556—0.570 — moderate agreement). A scoring tactical surgical classification of unstable gunshot wounds to the thoracolumbar spine was developed. Conclusion. AUC (0.866 for unstable and 0.888 for stable cases) allows the developed classification to be characterized as an “excellent classifier”. Considering 87.9% sensitivity and 72.3% specificity (for unstable cases), we can recommend this method for neurosurgeons and traumatologists to optimize treatment strategies for the wounded.