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

IF 1.7 Q2 SURGERY International Journal of Spine Surgery Pub Date : 2024-05-06 DOI:10.14444/8575

Chibuikem A Ikwuegbuenyi, François Waterkeyn, Arthur Okembo, Costansia Bureta, Kassim O Kassim, Hamisi K Shabani, Scott Zuckerman, Roger Härtl

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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.

Level of evidence: 4:

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东非胸椎、胸腰椎和腰椎创伤的表现、处理和结果：队列研究。

背景：胸椎、胸腰椎 (TL) 和腰椎创伤很常见，可导致残疾和神经功能缺损。本研究以东非一家三级医院的胸椎、胸腰椎和腰椎创伤患者为研究对象，旨在(1) 描述人口统计学和手术治疗模式，(2) 评估神经功能结果，(3) 报告与接受手术、神经功能改善和死亡率相关的预测因素：一家著名的东非转诊中心对 2016 年 9 月至 2020 年 12 月期间的患者记录进行了回顾性队列研究。研究收集了有关人口统计学、损伤和手术特征的数据。手术适应症使用AO（Arbeitsgemeinschaft für Osteosynthesefragen）TL骨折分类系统和神经功能进行评估。逻辑回归分析确定了手术治疗、神经功能改善和死亡率的预测因素：研究显示，257 名 TL 脊柱创伤患者中有 64.9% 接受了手术治疗，入院后中位住院日为 17.0 天。死亡率为 1.2%。43.6%的创伤是由道路交通事故造成的。最常见的骨折模式是AO A型骨折（78.6%）。97.6%的手术病例进行了椎板切除术和后外侧融合术。无神经功能缺损的患者（OR：0.27，95% CI：0.13-0.54，P <0.001）和从受伤到入院延迟时间较长的患者接受手术的可能性较低（OR：0.95，95% CI：0.92-0.99，P = 0.007）。神经功能改善率为 11.1%。单变量分析显示，手术与神经功能改善之间存在显著关联（OR：3.83，95% CI：1.27-16.61，P <0.001）。然而，这一结果在多变量回归中消失了：本研究强调了在低资源环境中处理 TL 脊柱创伤的各种主题，包括较低的手术率、从入院到手术的延迟、低死亡率的安全手术以及手术改善神经功能的潜力：临床相关性：尽管东非地区面临手术延迟和资源有限等挑战，但手术干预仍有可能改善胸椎、TL和腰椎创伤患者的神经功能预后：4:

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来源期刊

International Journal of Spine Surgery Medicine-Surgery

CiteScore

3.10

自引率

0.00%

发文量

162

期刊介绍： The International Journal of Spine Surgery is the official scientific journal of ISASS, the International Intradiscal Therapy Society, the Pittsburgh Spine Summit, and the Büttner-Janz Spinefoundation, and is an official partner of the Southern Neurosurgical Society. The goal of the International Journal of Spine Surgery is to promote and disseminate online the most up-to-date scientific and clinical research into innovations in motion preservation and new spinal surgery technology, including basic science, biologics, and tissue engineering. The Journal is dedicated to educating spine surgeons worldwide by reporting on the scientific basis, indications, surgical techniques, complications, outcomes, and follow-up data for promising spinal procedures.