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Mechanical Instability After Civilian Thoracolumbar Gunshot Injuries: A Systematic Review to Support Classification Development

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dc.contributor.authorRicciardi, Guillermo
dc.contributor.authorCirillo, Ignacio
dc.contributor.authorCabrera, Juan
dc.contributor.authorAlvarenga, Otávio
dc.contributor.authorNeves, Emiliano
dc.contributor.authorCarazzo, Charles
dc.contributor.authorDittmar, Michael
dc.contributor.authorGuiroy, Alfredo
dc.contributor.authorYurac, Ratko
dc.contributor.authorSchroeder, Gregory
dc.date.accessioned2026-09-30T15:04:06Z
dc.date.available2026-09-30T15:04:06Z
dc.date.issued2025
dc.description.abstractStudy DesignSystematic Review.ObjectivesIdentify risk factors for mechanical instability in thoracolumbar gunshot wounds to develop a new classification system.MethodsA systematic review following PRISMA 2020 guidelines was conducted across multiple databases from January 1, 1990, to September 12, 2024 (PROSPERO: CRD42023458804).ResultsOf 2400 records, 33 studies (3195 patients) met inclusion criteria, mostly retrospective and single-center, with varying definitions of instability. Direct comparison was limited due to clinical heterogeneity. Only 12 studies defined mechanical instability, mainly using the Denis three-column theory. Instability was reported in less than 10% of cases, except for one higher-rate outlier. The main markers included vertebral body comminution and potential ligamentous injury. Management was mainly conservative, with a low fixation rate (1.5-9.7%). Imaging relied on CT and static X-rays, with some studies advocating for dynamic radiographs.ConclusionThere is a lack of standardized definitions for mechanical instability in civilian thoracolumbar gunshot injuries. Four recurrent unstable patterns were detected, with vertebral body comminution as the most consistent marker. The need for a standardized classification system and further prospective studies is evident.
dc.description.versionVersión Publicada
dc.identifier.citationRicciardi, G. A., Cirillo, I., Cabrera, J. P., Alvarenga Pereira, O. V., Vialle, E. N., Carazzo, C., Dittmar, M., Guiroy, A., Yurac, R., & Schroeder, G. D. (2026). Mechanical Instability After Civilian Thoracolumbar Gunshot Injuries: A Systematic Review to Support Classification Development. Global spine journal, 16(2), 1300–1316. https://doi.org/10.1177/21925682251379371
dc.identifier.doihttps://doi.org/10.1177/21925682251379371
dc.identifier.urihttps://hdl.handle.net/11447/11210
dc.language.isoen
dc.subjectGunshot
dc.subjectMechanical stability
dc.subjectSpine
dc.subjectSpine fracture
dc.subjectSystematic review
dc.titleMechanical Instability After Civilian Thoracolumbar Gunshot Injuries: A Systematic Review to Support Classification Development
dc.typeArticle
dcterms.accessRightsAcceso Abierto
dcterms.sourceGlobal spine journal
dspace.entity.typePublication
relation.isAuthorOfPublication631830b2-9e94-4f76-bf44-70d266274dbc
relation.isAuthorOfPublication.latestForDiscovery631830b2-9e94-4f76-bf44-70d266274dbc

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