Gunshot Wounds to the Neck
Gunshot wounds to the neck are diagnostically and therapeutically challenging cases. We report such a case with vascular and neurologic injuries and describe the therapeutic options. Initial treatment is aimed at hemodynamic stabilization. Zone II neck injuries are managed selectively, and physical examination alone may dictate emergency surgical exploration. Spinal cord injury must be suspected and assessed clinically, as well as by computed tomography and angiography. Deteriorating or stable neurologic status and cord compression by bullet or bone fragments require surgical decompression. Improving neurologic status may be managed conservatively. In gunshot wounds to the neck, treatment should be individualized and multidisciplinary.

The incidence of penetrating spinal cord injuries due to gunshot wounds has risen steadily over the past decades. These injuries occur mostly in large metropolitan areas with high crime rates. Involvement of the cervical region is particularly challenging for the surgeon because of its unique anatomy and the potential for severe sequelae. We report the case of a young patient with a gunshot wound to the posterior cervical region. Apparent vascular and neurologic injuries were managed by neck exploration and clinical observation for spinal cord injury. We review our rationale for this diagnostic and therapeutic approach.