Outcome of fixation surgery in traumatic cervical injuries
Keywords:
spinal trauma, subaxial cervical fracture, surgical treatment, fixation, low-income countries.Abstract
Introduction: In a context of limited resources, the surgical treatment of traumatic cervical injuries is demanding.
Objective: To describe the initial experience of decompression and stabilization surgery in traumatic cervical injuries, in a single Nigerien hospital.
Methods: A retrospective observational study was conducted. All patients admitted with traumatic cervical injuries from September 2022 to March 2023, at Hôpital de Référence de Maradi, Niger, were included. A non-random, intentional sampling was used, through inclusion and exclusion criteria.
Results: Eleven cases were included. Automobile accidents represented the cause in 72.7 %. Five patients presented ASIA A and three ASIA B. Nine cases (81.8 %) showed type C fractures. The average time from admission and imaging diagnosis was 22 hours. The most injured anatomical level was C5-6 (63.6 %). The time from diagnosis and surgery averaged 11 days. All cases were operated using a single anterior approach. Only four patients did not show complications during their hospital stay. Five patients (45.4 %) received follow-up.
Conclusions: Surgical treatment of cervical fractures can be by a single anterior approach in scenarios with limited resources. Late surgery, due to logistical causes, showed higher incidence of hospital complications. Loss of follow-up makes it difficult to obtain data on the post-surgical evolution.
Downloads
References
Wilson CS, DeDios-Stern S, Bocage C, Gray AA, Crudup BM, Russell HF. A systematic review of how spinal cord injury impacts families. Rehabil Psychol. 2022;67(3):273-303. DOI: https://doi.org/10.1037/rep0000431
Admasu AK, Buno E. Short-term outcome in subaxial spine injury patients operated on in a resource-limited setting, Addis Ababa, Ethiopia. World Neurosurg. 2018;113:e702-6. DOI: https://doi.org/10.1016/j.wneu.2018.02.129
Lehre MA, Eriksen LM, Tirsit A, Bekele S, Petros S, Park KB, et al. Outcome in patients undergoing surgery for spinal injury in an Ethiopian hospital. J Neurosurg Spine. 2015;23(6):772-9. DOI: https://doi.org/10.3171/2015.3.SPINE141282
Liu Y, Shi CG, Wang XW, Chen HJ, Wang C, Cao P, et al. Timing of surgical decompression for traumatic cervical spinal cord injury. Int Orthop. 2015;39(12):2457-63. DOI: https://doi.org/10.1007/s00264-014-2652-z
Ojo OA, Poluyi EO, Owolabi BS, Kanu OO, Popoola MO. Surgical decompression for traumatic spinal cord injury in a tertiary center. Niger J Clin Pract. 2017;20(11):1455-60. DOI: https://doi.org/10.4103/njcp.njcp_303_16
Ogungbo B. Anterior decompression, fusion and plating in cervical spine injury: Early experience in Abuja, Nigeria. Surg Neurol Int. 2011;2:156. DOI: https://doi.org/10.4103/2152-7806.89854
Magogo J, Lazaro A, Mango M, Zuckerman SL, Leidinger A, Msuya S, et al. Operative treatment of traumatic spinal injuries in tanzania: surgical management, neurologic outcomes, and time to surgery. Glob Spine J. 2021;11(1):89-98. DOI: https://doi.org/10.1177/2192568219894956
Lessing NL, Lazaro A, Zuckerman SL, Leidinger A, Rutabasibwa N, Shabani HK, et al. Nonoperative treatment of traumatic spinal injuries in Tanzania: who is not undergoing surgery and why? Spinal Cord. 2020;58(11):1197-205. DOI: https://doi.org/10.1038/s41393-020-0474-y
Ter Wengel PV, de Gendt EEA, Martin E, Adegeest CY, Stolwijk-Swuste JM, Fehlings MG, et al. Impact of surgical timing on motor level lowering in motor complete traumatic spinal cord injury patients. J Neurotrauma. 2022;39(9-10):651-7. DOI: https://doi.org/10.1089/neu.2021.0428
Marchesini N, Demetriades A, Alves O, Sala F, Rubiano A. Exploring perspectives and adherence to guidelines for adult spinal trauma in low and middle-income healthcare economies: A survey on barriers and possible solutions (part I). Brain Spine. 2022;2:100932. DOI: https://doi.org/10.1016/j.bas.2022.100932
Demetriades A, Marchesini N, Alves O, Rubiano Escobar A, Sala F. A survey on the early management of spinal traumas in low and middle-income countries: From the scene of injury to diagnosis (part II). Brain Spine. 2022;2:101185. DOI: https://doi.org/10.1016/j.bas.2022.101185
Eaton J, Mukuzunga C, Grudziak J, Charles A. Characteristics and outcomes of traumatic spinal cord injury in a low-resource setting. Trop Doc. 2019;49(1):62-4. DOI: https://doi.org/10.1177/0049475518808969
Horta-Tamayo E, Babana A. Traumatic spinal cord injury in sub-Saharan Africa: a grim picture. Letter to editor. 2023. DOI: https://doi.org/10.13140/RG.2.2.22739.25123
Cripps RA, Lee BB, Wing P, Weerts E, Mackay J, Brown D. A global map for traumatic spinal cord injury epidemiology: towards a living data repository for injury prevention. Spinal Cord. 2011;49(4):493-501. DOI: https://doi.org/10.1038/sc.2010.146
Kang Y, Ding H, Zhou H, Wei Z, Liu L, Pan D, et al. Epidemiology of worldwide spinal cord injury: a literature review. J Neurorestoratol. 2020;6(1). DOI: https://doi.org/10.2147/JN.S143236
Zileli M, Osorio-Fonseca E, Konovalov N, Cardenas-Jalabe C, Kaprovoy S, Mlyavykh S, et al. Early management of cervical spine trauma: WFNS spine committee recommendations. Neurospine. 2020;17(4):710-22. DOI: https://doi.org/10.14245/ns.2040282.141
Zhu Y, Lu F, Zhang G, Liu Z. A review of strategies associated with surgical decompression in traumatic spinal cord injury. J Neurol Surg Part Cent Eur Neurosurg. 2023;84(6):570-7. DOI: https://doi.org/10.1055/a-1811-8201
Boever J, Mesfin F. A comparison of reported outcomes of anterior cervical spinal surgery among neurosurgeons in Africa and North America. World Neurosurg. 2021;146:e1097-102. DOI: https://doi.org/10.1016/j.wneu.2020.11.096
Doléagbénou AK, Djoubairou BO, Ahanogbé MKH, Egu K, Békéti AK, Kpélao E, et al. Surgical management of traumatic spinal injuries in Sylvanus Olympio Teaching Hospital. 2022. DOI: https://doi.org/10.21203/rs.3.rs-1695653/v1
Horta E, Acosta LC, Marrerro A. Reducción, estabilización interna y fusión por vía anterior en luxaciones cervicales subaxiales. MediCiego. 2023;28(1):2867. DOI: https://doi.org/10.5281/zenodo.12766042
Lee BJ, Jeong JH. Early decompression in acute spinal cord injury : review and update. J Korean Neurosurg Soc. 2023;66(1):6-11. DOI: https://doi.org/10.3340/jkns.2022.0107
Balas M, Guttman MP, Badhiwala JH, Lebovic G, Nathens AB, da Costa L, et al. Earlier surgery reduces complications in acute traumatic thoracolumbar spinal cord injury: analysis of a multi-center cohort of 4108 patients. J Neurotrauma. 2022;39(3-4):277-84. DOI: https://doi.org/10.1089/neu.2020.7525
Azad TD, Nair SK, Kalluri AL, Materi J, Ahmed AK, Khalifeh J, et al. Delays in presentation after traumatic spinal cord injury-a systematic review. World Neurosurg. 2023;169:e121-30. DOI: https://doi.org/10.1016/j.wneu.2022.10.086
Zuckerman SL, Haghdel A, Lessing NL, Carnevale J, Cheserem B, Lazaro A, et al. Cervical spine trauma in east Africa: presentation, treatment, and mortality. Int J Spine Surg. 2021;15(5):879-89. DOI: https://www.ijssurgery.com/content/15/5/879
Balasubramanian A, Shanmugam G. Delayed presentation of subaxial cervical spine dislocations: A retrospective review of 14 cases managed at a specialist spinal surgery unit in Durban, South Africa. East Cent Afr J Surg. 2020 [acceso 24/02/2023];25(3). Disponible en: http://journal.cosecsa.org/index.php/ECAJS/article/view/20200002
