Gunshot wounds of the spine: should retained bullets be removed to prevent infection?

We have investigated the role of retained bullets and other possible risk factors in the development of local septic complications after gunshot wounds (GSW) of the spine. Of 153 patients with GSW of the spine followed up for a mean of 28 months, the overall incidence of bullet wound related septic complications was 9.8%. In 81 patients the bullet was retained and the incidence of local septic complications was 7.4%. In 72 patients the bullet left the body (70) or was removed on admission (2), and the sepsis rate was 12.5% (P > 0.05). In 24 patients there was an associated colonic injury and the incidence of sepsis was 8.4% compared with 5% in the group of patients with intra-abdominal injuries but no colonic trauma (P > 0.05). The incidence of septic complications in lumbar spine injuries was significantly higher than in thoracic and cervical spine injuries (P > 0.05). We believe that in GSW of the spine, retained bullets do not increase the likelihood of septic complications.