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Gunshot wounds to the spine are a devastating calamity. Specific literature is scarce, as are large series. In the absence of extensive data, it is difficult to evaluate the complications and the effect of the several forms of treatment. The objective of this study was to add information to improve the handling of the pathology. This review was based on the analysis of 246 patients with gunshot wounds to the spine admitted to the Hospital da Restauração, Recife, Brazil, between January 1981 and June 1998. Eleven patients (4.5%) were female. The age of the patients ranged from 10 to 65 years. The neurologic condition was judged according to the classification of Frankel/ASIA/IMSOP. In grade A there were 147 (59.8%) patients; in B, 6 (2.4%); in C, 51 (20.8%); in D, 35 (14.2%); and in E, 7 (2.8%). All patients underwent radiologic investigation, and 51 (20.7%) underwent computed tomography. The hospital stay ranged from 3 to 182 days. Follow-up ranged from 3 to 397 days (mean 76.3 days). One hundred fifty-seven (63.8%) patients were managed conservatively and 89 (36.2%) underwent surgical treatment. Thirty-five (14.2%) patients died. Decompressive laminectomies were associated with a higher level of complications and did not improve patient outcome. The authors strongly recommend that a prospective multicenter study should be organized with a larger population of patients to allow a better understanding of the complexity of this pathology.