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. 2024 May 6;18(2):186-198.
doi: 10.14444/8575.

Presentation, Management, and Outcomes of Thoracic, Thoracolumbar, and Lumbar Spine Trauma in East Africa: A Cohort Study

Chibuikem A Ikwuegbuenyi  1   2 , François Waterkeyn  3 , Arthur Okembo  2 , Costansia Bureta  2 , Kassim O Kassim  2 , Hamisi K Shabani  2 , Scott Zuckerman  4 , Roger Härtl  5
Affiliations

Presentation, Management, and Outcomes of Thoracic, Thoracolumbar, and Lumbar Spine Trauma in East Africa: A Cohort Study

Chibuikem A Ikwuegbuenyi et al. Int J Spine Surg. .

Abstract

Background: Trauma to the thoracic, thoracolumbar (TL), and lumbar spine is common and can cause disability and neurological deficits. Using a cohort of patients suffering from thoracic, TL, and lumbar spine trauma in a tertiary hospital in East Africa, the current study sought to: (1) describe demographics and operative treatment patterns, (2) assess neurologic outcomes, and (3) report predictors associated with undergoing surgery, neurologic improvement, and mortality.

Methods: A retrospective cohort study of patient records from September 2016 to December 2020 was conducted at a prominent East Africa referral center. The study collected data on demographics, injury, and operative characteristics. Surgical indications were assessed using the AO (Arbeitsgemeinschaft für Osteosynthesefragen) TL fracture classification system and neurological function. Logistic regression analysis identified predictors for operative treatment, neurologic improvement, and mortality.

Results: The study showed that 64.9% of the 257 TL spine trauma patients underwent surgery with a median postadmission day of 17.0. The mortality rate was 1.2%. Road traffic accidents caused 43.6% of the injuries. The most common fracture pattern was AO Type A fractures (78.6%). Laminectomy and posterolateral fusion were performed in 97.6% of the surgical cases. Patients without neurological deficits (OR: 0.27, 95% CI: 0.13-0.54, P < 0.001) and those with longer delays from injury to admission were less likely to have surgery (OR: 0.95, 95% CI: 0.92-0.99, P = 0.007). The neurologic improvement rate was 11.1%. Univariate analysis showed a significant association between surgery and neurologic improvement (OR: 3.83, 95% CI: 1.27-16.61, P < 0.001). However, this finding was lost in multivariate regression.

Conclusions: This study highlights various themes surrounding the management of TL spine trauma in a low-resource environment, including lower surgery rates, delays from admission to surgery, safe surgery with low mortality, and the potential for surgery to lead to neurologic improvement.

Clinical relevance: Despite challenges such as surgical delays and limited resources in East Africa, there is potential for surgical intervention to improve neurologic outcomes in thoracic, TL, and lumbar spine trauma patients.

Keywords: LMICs; Tanzania; spine trauma; thoracolumbar; traumatic spinal cord injury.

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Figures

Figure 1
Figure 1
Fracture types among 257 thoracic, thoracolumbar, and lumbar spine trauma patients (each fracture type counted separately when more than 1 injury was present).
Figure 2
Figure 2
(A–C) Axial, sagittal, and coronal preoperative computed tomography images of a patient with L1 burst fracture. (D, E) Intraoperative x-ray anteroposterior and lateral views after instrumentation.
See this image and copyright information in PMC

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References

    1. Magogo J, Lazaro A, Mango M, et al. . Operative treatment of traumatic spinal injuries in Tanzania: surgical management, neurologic outcomes, and time to surgery. Global Spine J. 2021;11(1):89–98. 10.1177/2192568219894956 - DOI - PMC - PubMed
    1. Chanbour H, Chen JW, Ehtesham SA, et al. . Time to surgery in spinal trauma: a meta-analysis of the world’s literature comparing high-income countries to low-middle income countries. World Neurosurg. 2022;167:e268–e282. 10.1016/j.wneu.2022.07.140 - DOI - PubMed
    1. Kumar R, Lim J, Mekary RA, et al. . Traumatic spinal injury: global epidemiology and worldwide volume. World Neurosurg. 2018;113:e345–e363. 10.1016/j.wneu.2018.02.033 - DOI - PubMed
    1. Weiser TG, Regenbogen SE, Thompson KD, et al. . An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet. 2008;372(9633):139–144. 10.1016/S0140-6736(08)60878-8 - DOI - PubMed
    1. Ahuja CS, Badhiwala JH, Fehlings MG. Time is spine: the importance of early intervention for traumatic spinal cord injury. Spinal Cord. 2020;58(9):1037–1039. 10.1038/s41393-020-0477-8 - DOI - PMC - PubMed

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