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Daily Archives: August 13, 2010

Q&A: How Would a Gunshot Wound to the Spine Be Treated and Rehabilitated?

Q: In my novel, the main character is a homicide detective who is shot in the back. The bullet lodges between her T11 and T12 vertebrae, cutting into her spinal cord and leaving her paralyzed from the waist down. What would be a reason for the doctors to remove the bullet immediately and how long would she be in the hospital before rehabilitation was started? Also, what type of rehabilitation would she face, how long would it be before she could return home and what type of job opportunities would the police department offer her?

DCooper, Sewell NJ

A: Surgery would be done to control any bleeding and to attempt to salvage as much spinal function as possible. With this type of injury there would be direct damage to the spinal cord by the bullet and indirect damage from the fractured vertebrae in the area and from pressure as blood accumulated in what we call a hematoma. This is simply a mass of blood and it can apply pressure to the cord and make things initially look worse than they are. The surgeon would remove the bullet—if possible. He might or might not since removing it could cause more injury than leaving it in place. Usually though it is removed. He would remove any hematoma that had collected, control any bleeding, and repair the damaged vertebrae if possible. The surgery would probably be done by a neurosurgeon and an orthopedic surgeon, working together.

Recovery is extremely variable and depends upon the exact nature of the injury, the effectiveness of the surgery, the person it happens to, and luck. So you can have it go almost anyway you want. Full recovery is possible, full paraplegia (paralysis below the waist) is possible, and anywhere in between. Rehab is usually begun in the hospital a few days after surgery and continued after discharge. She might be in an ICU for 3 or 4 days, a regular hospital surgical bed for a week (here is where rehab would begin with simple range of motion exercises as possible and passive movement of the limbs, etc), and then she would be transferred to an in-hospital rehab unit for a few weeks. This is all very general and depends upon what’s happening with the victim and the level of sophistication of the hospital.

If she indeed suffered permanent paralysis, she could perform any type of desk job such as dispatcher, records custodian, that kind of thing. She could also begin a new career in the crime lab. Many crime lab techs are previous police officers who then train on the job in such things as fingerprints, firearms, etc.

 
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Posted by on August 13, 2010 in Medical Issues, Q&A, Trauma

 
 
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