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

      Zuckerman, Scott L; Haghdel, Arsalan; Lessing, Noah L; Carnevale, Joseph; Cheserem, Beverly; Lazaro, Albert; Leidinger, Andreas; Rutabasibwa, Nicephorus; Shabani, Hamisi K; Mangat, Halinder; et al. (International Society for the Advancement of Spine Surgery, 2021-09-22)
      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 = .011) and an incomplete injury (OR 3.64; 95% CI 1.19–12.25; P = .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 = .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.
    • Cervical Spine Trauma in East Africa: Presentation, Treatment, and Mortality.

      Zuckerman, Scott L; Haghdel, Arsalan; Lessing, Noah L; Carnevale, Joseph; Cheserem, Beverly; Lazaro, Albert; Leidinger, Andreas; Rutabasibwa, Nicephorus; Shabani, Hamisi K; Mangat, Halinder; et al. (ISASS, 2021-09-22)
      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.
    • Cost-Effectiveness of Operating on Traumatic Spinal Injuries in Low-Middle Income Countries: A Preliminary Report From a Major East African Referral Center

      Lessing, Noah L.; Zuckerman, Scott L.; Lazaro, Albert; Leech, Ashley A.; Leidinger, Andreas; Rutabasibwa, Nicephorus; Shabani, Hamisi K.; Mangat, Halinder S.; Härtl, Roger (SAGE Publications Inc., 2020-01-01)
      Study Design: Retrospective cost-effectiveness analysis. Objectives: While the incidence of traumatic spine injury (TSI) is high in low-middle income countries (LMICs), surgery is rarely possible due to cost-prohibitive implants. The objective of this study was to conduct a preliminary cost-effectiveness analysis of operative treatment of TSI patients in a LMIC setting. Methods: At a tertiary hospital in Tanzania from September 2016 to May 2019, a retrospective analysis was conducted to estimate the cost-effectiveness of operative versus nonoperative treatment of TSI. Operative treatment included decompression/stabilization. Nonoperative treatment meant 3 months of bed rest. Direct costs included imaging, operating fees, surgical implants, and length of stay. Four patient scenarios were chosen to represent the heterogeneity of spine trauma: Quadriplegic, paraplegic, neurologic improvement, and neurologically intact. Disability-adjusted-life-years (DALYs) and incremental-cost-effectiveness ratios were calculated to determine the cost per unit benefit of operative versus nonoperative treatment. Cost/DALY averted was the primary outcome (i.e., the amount of money required to avoid losing 1 year of healthy life). Results: A total of 270 TSI patients were included (125 operative; 145 nonoperative). Operative treatment averaged $731/patient. Nonoperative care averaged $212/patient. Comparing operative versus nonoperative treatment, the incremental cost/DALY averted for each patient outcome was: quadriplegic ($112-$158/DALY averted), paraplegic ($47-$67/DALY averted), neurologic improvement ($50-$71/DALY averted), neurologically intact ($41-$58/DALY averted). Sensitivity analysis confirmed these findings without major differences. Conclusions: This preliminary cost-effectiveness analysis suggests that the upfront costs of spine trauma surgery may be offset by a reduction in disability. LMIC governments should consider conducting more spine trauma cost-effectiveness analyses and including spine trauma surgery in universal health care. © The Author(s) 2020.