Cervical Spine Trauma in East Africa: Presentation, Treatment, and Mortality
Author
Zuckerman, Scott LHaghdel, Arsalan
Lessing, Noah L
Carnevale, Joseph
Cheserem, Beverly
Lazaro, Albert
Leidinger, Andreas
Rutabasibwa, Nicephorus
Shabani, Hamisi K
Mangat, Halinder
Härtl, Roger
Date
2021-09-22Journal
International Journal of Spine SurgeryPublisher
International Society for the Advancement of Spine SurgeryType
Article
Metadata
Show full item recordAbstract
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.Rights/Terms
This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery. Copyright © 2021 ISASS.Identifier to cite or link to this item
http://hdl.handle.net/10713/16731ae974a485f413a2113503eed53cd6c53
10.14444/8113
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