The role of neurosurgical intervention in penetrating spinal injury has not been clearly established. Functional outcome has not been shown to be influenced by operation. In fact, neurosurgical intervention has been shown to potentially increase the risk of serious complications. This paper examines a unique subset of patients with penetrating spinal injury—those secondary to shotguns. An analysis of five such cases and a review of the limited literature on the subject suggests that neurosurgical intervention is of limited value in such injuries and that initial management should focus primarily upon non-neurological injuries.