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. 2019 Jan 15;19(1):10.
doi: 10.1186/s12883-019-1236-3.

Epidemiology of non-traumatic spinal cord injury in Uganda: a single center, prospective study with MRI evaluation

Abdu K Musubire  1   2 , David B Meya  3   4 , Elly T Katabira  4 , Ana Claire L Meyer  5 , Paul R Bohjanen  6 , David R Boulware  6 , Frank Minja  7
Affiliations

Epidemiology of non-traumatic spinal cord injury in Uganda: a single center, prospective study with MRI evaluation

Abdu K Musubire et al. BMC Neurol. .

Abstract

Background: A few reliable national data concerning the etiology of non-traumatic spinal cord injury (SCI) in sub-Sahara Africa exists, mainly because of the limitations of diagnostic imaging. These are both expensive and mostly unavailable in several resource-limited settings. Only a few studies have employed the magnetic resonance imaging (MRI) in documenting non-traumatic SCI and most of these studies are from South Africa. We sought to describe the clinical presentation, MRI radiological patterns, and one-year survival among subjects with non-traumatic SCI in Uganda.

Methods: We enrolled a prospective cohort of 103 participants with non-traumatic SCI at Mulago National Referral Hospital Kampala, Uganda in 2013-2015. Participants received standard of care management, with surgical intervention as needed, with one-year follow up. Data were analyzed using Descriptive statistics.

Results: In 103 participants with non-traumatic SCI, the median (IQR) age was 37 (18, 85) years and 25% of the participants were HIV-infected. Paraplegia/paraparesis was the most common clinical presentation in 70% (n = 72). Severe disease was present in 82% (n = 85) as per American Spinal Injury Association (ASIA) scale A-C. On MRI, 50% had extradural lesions. However, bone lesions accounted for only 75% of all the extradural lesions. More than 60% of the patients had lesions that could only be diagnosed on MRI. Deaths occurred in 42% (n = 44) of participants, with the highest mortality among those with extradural lesions (60%).

Conclusion: The mortality following non-traumatic spinal cord injuries in Uganda is high. We demonstrated an equal distribution between extradural and intradural lesions, which differs from the historical predominance of extradural lesions. Increased utilization of MRI particularly among young age groups is needed to make a diagnosis.

Keywords: MRI; Mortality; Myelopathy; Non-traumatic spinal cord injury; Sub-Saharan Africa; Uganda.

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Conflict of interest statement

Ethics approval and consent to participate

Makerere University Research and Ethics Committee and the Uganda National Council for Science and Technology provided ethical approval for the study and all patients provided a written consent to participate in the study.

Consent for publication

This manuscript does not contain any identifiable personal data of the participants and hence the consent for the publication of identifying images or other personal or clinical details of participants that compromise anonymity is not applicable to this manuscript.

Competing interests

David Meya is an Editorial Board Member (associate editor) of BMC Neurology. I declare that there were no competing interests for this work among the other authors.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Study Flow Diagram. Patients with no lesions on MRI with strong clinical suspicion for non-traumatic spinal cord injury were categorized under Intramedullary lesions
Fig. 2
Fig. 2
Extradural bone lesions with the diagnosis of degenerative disease and TB infection. a Cervical spondylosis diagnosed in a 60–64 year-old participant with quadriparesis for > 2 months. T2 Hyperintensity at C2 and C3 with multiple posterior disc prolapses at C3-C6. The patient died at home 2 months later having refused orthopedic surgery. b 45–49 year-old participant presented with progressive quadriparesis for over 3 months with a C4 and C5 vertebra bone destructive lesion who underwent surgery with a biopsy that confirmed acid-fast bacilli consistent with Potts’ disease
Fig. 3
Fig. 3
Intradural Lesions with a diagnosis of Transverse Myelitis. T2 hyperintensity lesion T8-T12 in a 20–24 year-old participant who presented with progressive paraplegia over 3 weeks. A diagnosis of transverse myelitis was made and the patient improved on steroids
See this image and copyright information in PMC

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