Epidemiology of severe cervical spinal trauma in the north area of São Paulo City: a 10-year prospective study

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>The main objective was to study the epidemiological data obtained in patients with cervical spinal trauma (CST) in the north area of São Paulo City between 1997 and 2006.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>All patients with severe CST in the north area of São Paulo City were studied. The data analyzed were age, sex, incidence, causes of trauma, level of trauma, morbidity, deaths, and complications. Analytical tests were performed to study risks of trauma and complications. The chi-square and analysis of variance tests were used for analytical data (significance level p &lt; 0.05).</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>The study population consisted of 217 patients who were hospitalized for CST. The average incidence rate was 21.6 cases annually or 1.8 cases monthly. The mean patient age was 36.75 years. The 20–40-year-old age bracket was found to be most highly represented, corresponding to 52.6% of total patients. Patients were predominantly male; 191 patients (88.01%) were male compared with only 26 female patients (11.99%). The ratio of men to women was 7.35:1. Injuries in the craniocervical region corresponded to 43 (19.8%) of the cases; injuries in the cervical subaxial region corresponded to 174 (80.2%) of the cases and were associated with worse neurological lesions. Additionally, 40.6% of patients presented with complications in other organs and systems; several patients presented with multiple complications, and 33 patients (15.02%) died. During the hospitalization period, 4 patients presenting as Grade A on the American Spinal Injury Association (ASIA) Scale evolved to Grade C, 1 patient presenting as ASIA Grade A evolved to Grade B, and 2 patients evolved to Grade E. Two patients who had been admitted without neurological lesions evolved to ASIA Grade C (1 patient postsurgery and 1 patient post-traction). Two patients presenting initially as ASIA Grade E evolved to Grade D, and another to central cord syndrome. On average, patients with incomplete lesions improved 1 grade in ASIA classification during hospitalization.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Data from severe CST observed in the current study suggest many differences in the characteristics described in the majority of published epidemiological studies and those found in patients in the north area of São Paulo City. It is likely that these differences reflect the urban and cultural habits and behaviors of the population specific to this area.</jats:p></jats:sec>

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“…8 Comparando os dados deste estudo com os demais analisados, os resultados de nosso levantamento corroboram a predominância do sexo masculino nesse tipo de patologia traumática. É o que podemos verificar nos estudos de Brito et al, 3 Santos et al 4 e Hasler et al 5 Todos apresentam mais de 60% de prevalência masculina nos casos de trauma na coluna vertebral.…”

“…No trabalho de Santos et al, 4 a proporção entre homens e mulheres foi de 7,35:1, enquanto o nosso obteve um índice de 2,71:1. Embora a prevalência masculina tenha sido mantida, chama a atenção a maior desproporção entre homens e mulheres daquele estudo.…”

“…É dividida em cervical (7), torácica (12), lombar (5), sacral (5) e coccígea (4). As duas últimas são fundidas e formam o sacro, sendo denominadas vértebras falsas ou fixas.…”

“…Tais números seguem aumentando a cada década. 4 A incidência/prevalência exata de lesão medular traumática no Brasil é desconhecida, pois essa condição não é sujeita à notificação e há poucos dados e trabalhos publicados a respeito da epidemiologia da lesão espinhal. Estima-se que ocorram a cada ano no país mais de 10 mil novos casos de lesão medular, sendo o trauma a causa predominante.…”

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“…1 Em alguns estudos a coluna cervical é o segmento mais acometido nas fraturas da coluna vertebral, representando cerca de 45-60% de todos os casos, com elevada taxa de morbidade e mortalidade. 2 Apresentamos o perfil epidemiológico e os fatores de risco para déficit neurológico de 48 pacientes com fratura traumática da coluna cervical tratados cirurgicamente no serviço de neurocirurgia do Hospital de Base do Distrito Federal. É um serviço de referência, da capital federal e do centro-oeste brasileiro, no tratamento do traumatismo raquimedular, com realização média de 100 cirurgias por ano para correção de fraturas vertebrais.…”