Cervical Spine Trauma in East Africa: Presentation, Treatment, and Mortality

Abstract

Background: Cervical spine trauma (CST) leads to devastating neurologic injuries. In a cohort of CST patients from a major East Africa referral center, we sought to (a) describe presentation and operative treatment patterns, (b) report predictors of neurologic improvement, and (c) assess predictors of mortality.Methods: A retrospective, cohort study of CST patients presenting to a tertiary hospital in Dar Es Salaam, Tanzania, was performed. Demographic, injury, and operative data were collected. Neurologic exam on admission/ discharge and in-hospital mortality were recorded. Univariate/multivariate logistic regression assessed predictors of operative treatment, neurologic improvement, and mortality.Results: Of 101 patients with CST, 25 (24.8%) were treated operatively on a median postadmission day 16.0 (7.0-25.0). Twenty-six patients (25.7%) died, with 3 (12.0%) in the operative cohort and 23 (30.3%) in the nonoperative cohort. The most common fracture pattern was bilateral facet dislocation (26.7%). Posterior cervical laminectomy and fusion and anterior cervical corpectomy were the 2 most common procedures. Undergoing surgery was associated with an injury at the C4-C7 region versus occiput-C3 region (odds ratio [OR] 6.36, 95% confidence interval [CI] 1.71-32.28, P ¼ .011) and an incomplete injury (OR 3.64; 95% CI 1.19-12.25; P ¼ .029). Twelve patients (15.8%) improved neurologically, out of the 76 total patients with a recorded discharge exam. Having a complete injury was associated with increased odds of mortality (OR 11.75, 95% CI 3.29-54.72, P , .001), and longer time from injury to admission was associated with decreased odds of mortality (OR 0.66, 95% CI 0.48-0.85, P ¼ .006).Conclusions: Those most likely to undergo surgery had C4-C7 injuries and incomplete spinal cord injuries. The odds of mortality increased with complete spinal cord injuries and shorter time from injury to admission, probably due to more severely injured patients dying early within 24-48 hours of injury. Thus, patients living long enough to present to the hospital may represent a self-selecting population of more stable patients. These results underscore the severity and uniqueness of CST in a less-resourced setting.Level of Evidence: 4.

Letter: Appraising the Recent Management Gaps for Spinal Cord Injuries in Low-Resource Settings: The Case of Sub-Saharan African Countries

“…6 The primary management plans for SCIs are early stabilization and mobilization with active physiotherapy; however, several factors have hampered achieving these goals. Financial constraints cause diagnostic delays, 1,2,7 and some African families are unaware of the importance of diagnostic imaging for intervention planning. 1 The population generally lacks well-structured insurance schemes to cover most diagnostic costs.…”

Non-Communicable Neurological Disorders and Neuroinflammation

“…Traumatic brain (TBI) and spinal cord injuries (SCI) are significantly increased in low-medium income countries of Africa, as compared to the rest of the globe ( 3 , 4 ). The mean incidence is twice as high, approximatively 300/100,000 for TBI and 130 cases per million for SCI ( 3 , 4 ). However, incidence distribution is not homogenous, some African nations being more affected than others ( 3 ).…”

Acute spinal cord injury in Africa: exploring the long-term outcomes and future directions of acute spinal cord injury – short communication

“…The high socioeconomic burden is especially high in the low- and middle-income countries (LMICs), where some nations spend over $2 billion annually, including $5 million per case of paraplegia and $9.5 million per case of quadriplegia. In most LMICs, patients also rely excessively on family members for care as rehabilitation services are not sufficient with the survival rates being lower in comparison with the high-income countries (HICs) 2 , 4 . In addition, over 90% of the African population does not have access to formal emergency medical services, and prehospital care in sub-Saharan Africa and other resource-limited LMICs is poorly defined.…”