Spine trauma: pattern, causes and surgical outcome

Abstract

ABSTRACT Background: Spinal cord injury (SCI) is a devastating neurological injury, resulting in varying degrees of paralysis, sensory loss and sphincter disturbance which are permanent and irreversible in cases. The major cause of spinal cord injuries (SCI) is motor vehicular crashes (MVC). Objectives: The aim of this study was to examine the pattern, causes and early surgical outcome of spine injury, as seen at Chris Hani Baragwanath hospital, in Johannesburg, South Africa. Materials and methods: Age, sex, cause of spine injury, pattern of SCI, neurologic status on admission to hospital and eventual outcome of patients treated surgically for SCI from January 2008 to November 2010, were retrospectively studied from case notes. Data were analyzed using SPSS 16.0. Results: A total of 80 patients who sustained spine injury, who fulfilled the inclusion criteria, were studied. The mean age of the patient was 36.09 years, age ranging from 4 years to 87 years. Males were affected more than females, with a male to female ratio of 3:1. The most affected individuals were young adults in the age group 21 -40 years (58.75%), followed by middle aged persons i.e. age group 41 -60 years (31.25%). The elderly represented the minority (3.75%). Motor Vehicle crashes (MVC) was the most common cause of injury, constituting 52.5% of all spine injuries. The cervical spine was the most affected segment of the spine 47.5% and MVC was the commonest cause of these injuries (25%). viii On admission to hospital, most patients presented with complete neurological deficit, i.e. ASIA A. (48.75%) ASIA A on admission had poor neurological recovery and only 3 (3.75%) patients had improvement on discharge. Both anterior and posterior approaches were used for surgical stabilization. Patients who showed neurological recovery were those with partial deficit on admission. The mean duration of hospital stay was 40 days, with a minimum of 2 days and maximum of 343 days. Six (7.5%) patients died as a result of spine injury, all death belonged to cervical spine injury category. Conclusion: SCI has emerged as a significant cause of morbidity and mortality in South Africa and the developing world at large. The patients are mostly male adult, sustaining injury following MVC. The cervical spine was the most common level of injury. Neurologic outcome was satisfactory in a high number of the patients with incomplete injury. Recommendations: · Training of spine and neurosurgeons and enforcement of road traffic rules as MVC is major cause of spine injury. · Public awareness of how to assist a spine injured patient at the scene, would help reduce conversion of incomplete to complete spine injury · Early referral of patients and early surgery may improve outcome of patients