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Penetrating spinal cord injury: a systematic review and meta-analysis of clinical features and treatment outcomes



To systematically review the literature on penetrating spinal cord injury (PSCI) and evaluate current management strategies, their impact on patient functional outcomes, and treatment complications.


PubMed, Scopus, and Cochrane were searched based on the Preferred Reporting Items for Systematic-Reviews and Meta-Analyses (PRISMA) guidelines to include studies on penetrating spinal cord injury (PSCI).


We included 10 articles comprising 1754 cases of PSCI. Mean age was 19.2 years (range, 16–70), and most patients were male (89.9%). Missile spinal cord injury (MSCI) was the most common type, affecting 1623 patients (92.6%), while non-missile spinal cord injury (NMSCI) accounted for only 131 cases (7.4%). Gunshots were the most common cause of MSCI, representing 87.2%, while knife stabs were the most common cause of NMSCI, representing 72.5%. A total of 425 patients (28.0%) underwent surgical intervention, and 1094 (72.0%) underwent conservative management. The conservative group had a higher rate of complete spine cord injury compared with the surgical group (61.5% vs. 49.2; p < 0.001). Although surgery yielded a higher score improvement rate compared with the conservative management (41.5% vs. 20.5%, p < 0.001), neither treatment strategy displayed superiority in improving neurological outcomes for neither complete SCIs (OR:0.7, 95% CI, 0.3–1.64; I2 = 44%, p = 0.13) nor for incomplete SCIs (OR:1.15, 95% CI, 0.64–2,06; I2 = 40%, p = 0.12).


Surgical and conservative management strategies proved to be equally effective on PSCI, irrespective of injury severity. Therefore, tailored treatment strategies for each patient and careful surgical selection is advised.

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Fig. 1: PRISMA flowchart of the search strategy.
Fig. 2: Bar chart comparing ASIA score at admission and discharge between the treatment modalities.
Fig. 3

Data availability

Data were generated using the included articles’ reported data. Data are available from the corresponding author on reasonable request.


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Authors and Affiliations



All authors contributed to the study conception and design. The study idea was proposed by [Othman Bin Alamer, MBBS] and [Ali S. Haider, BS]. The literature search, articles screen, and data extraction were perfumed by [Caren Stuebe, MSc], [Paolo Palmisciano, MD], [Lokeshwar S. Bhenderu, BS], [Navraj S. Sagoo, MD], [Maryam Haider, MD], and [Ali S. Haider, BS]. Data analysis was performed by [Othman Bin Alamer, MBBS]. The manuscript was drafted by [Othman Bin Alamer, MBBS]. All authors critically revised and edited the first draft and commented on all versions of the manuscript.

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Correspondence to Othman Bin-Alamer.

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Bin-Alamer, O., Bhenderu, L.S., Stuebe, C. et al. Penetrating spinal cord injury: a systematic review and meta-analysis of clinical features and treatment outcomes. Spinal Cord (2022).

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