Management of lumbar gunshot spine injuries with minimally invasive techniques: a compelling case study and scoping review

Background: Spinal gunshot wounds (GSWs) injuries are a leading cause of permanent disability, and their management remains debated. Traditional open surgery has not consistently improved neurological outcomes and can increase morbidity. Minimally invasive spine surgery (MISS) offers less disruptive options. This study evaluates the safety and effectiveness of MISS for lumbar GSW injuries.

Methods: A scoping review was conducted following PRISMA-ScR guidelines, using PubMed, WOS, Embase, and Scopus to gather literature on minimally invasive surgical management of lumbar spinal GSW injuries from January 2000 until October 2025. Key data on surgical indications, timing, techniques, neurological outcomes, pain, complications, and intraoperative parameters were analyzed. A clinical case from our institution was also presented.

Results: Eight studies involving 15 patients, along with our case, were reviewed. In the acute phase, surgical indications included neurological deficits, intrathecal migration, and cerebrospinal fluid (CSF) leakage, while in the chronic focused on pain management and metal toxicity. MISS techniques such as tubular or endoscopic decompression and endoscopic fusion were used. Our analysis showed significant postoperative pain reduction, rapid mobilization and documented neurological improvement in 66.7% of evaluable patients with no instances of postoperative infections or persistent CSF leaks. MISS techniques preserved spinal stability, facilitated fragment retrieval, minimized tissue trauma, and maintained forensic integrity.

Conclusions: MISS is a safe and effective option for treating symptomatic lumbar GSWs, suitable for both acute and chronic cases. Its advantages include a favorable safety profile, preserved spinal stability, faster recovery. Although current evidence is limited by small sample sizes and the retrospective nature of available studies, MISS seems to offer a valuable alternative to conservative and standard surgical methods for lumbar penetrating trauma.