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

Guillermo Alejandro Ricciardi; Ignacio Cirillo; Juan Pablo Cabrera; Otávio Vitório Alvarenga Pereira; Emiliano Neves Vialle; Charles Carazzo; Michael Dittmar; Alfredo Guiroy; YURAC BARRIENTOS, RATKO JOVAN; Gregory D. Schroeder

doi:10.1177/21925682251379371

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

Journal

Global Spine Journal

ISSN

2192-5682

Date Issued

2025-09-11

Author(s)

Guillermo Alejandro Ricciardi

Ignacio Cirillo

Juan Pablo Cabrera

Otávio Vitório Alvarenga Pereira

Emiliano Neves Vialle

Charles Carazzo

Michael Dittmar

Alfredo Guiroy

YURAC BARRIENTOS, RATKO JOVAN

Facultad de Medicina Clínica Alemana Universidad del Desarrollo

Gregory D. Schroeder

Type

journal-article

DOI

10.1177/21925682251379371

URL

https://hdl.handle.net/123456789/11510

Abstract

Study Design Systematic Review.Objectives Identify risk factors for mechanical instability in thoracolumbar gunshot wounds to develop a new classification system.Methods A systematic review following PRISMA 2020 guidelines was conducted across multiple databases from January 1, 1990, to September 12, 2024 (PROSPERO: CRD42023458804).Results Of 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.Conclusion There 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.

Cite this document

Ricciardi, 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. (2025). Mechanical instability after civilian thoracolumbar gunshot injuries: A systematic review to support classification development. Global Spine Journal, 21925682251379371. https://doi.org/10.1177/21925682251379371