Ricciardi, GuillermoCirillo, IgnacioCabrera, JuanAlvarenga, OtávioNeves, EmilianoCarazzo, CharlesDittmar, MichaelGuiroy, AlfredoYurac, RatkoSchroeder, Gregory2026-09-302026-09-302025Ricciardi, 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/10.1177/21925682251379371https://hdl.handle.net/11447/11210Study 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.enGunshotMechanical stabilitySpineSpine fractureSystematic reviewArticlehttps://doi.org/10.1177/21925682251379371