Traumatic spinal cord injuries in Mulago Hospital: Types, treatment and short term outcomes.

Abstract

BACKGROUND: Spinal cord injuries (SCIs) represent a significant proportion of traumatic injuries worldwide with a prevalence of 8.8% in Uganda [1]. Neurological outcomes after clinical care and inpatient rehabilitation are greatly affected by lack of well-equipped rehabilitation centers and no documented study on neurological functional outcomes and complications after SCI. With increasing progress in neuroscience research and the growing availability of advanced interventions, the idea of spinal-cord injury repair is becoming plausible especially in the advanced settings. This study aimed at determining types, treatment and short term neurological outcomes and complications of spinal cord injuries in Mulago Hospital. METHODOLOGY: A descriptive, prospective cohort study was conducted in Mulago national referral hospital during the period 1st September 2011 to 31st January 2012, a total of 51 patients with acute SCIs were enrolled through consecutive sampling. Clinical and radiological evaluations were done and the patients were subjected to surgical and non surgical interventions depending on their state. They were then followed up and rehabilitated for 30 days. Outcome measures were functional independence measure (FIM), (motor, self-care, sphincter control), complications (pressure sores, UTI, pneumonia, ileus, constipation, DVT). Data was entered in epidata and analysed in SPSS. RESULTS The mean age of the patients was 35 years (8-65yrs) with male to female ratio of 9:1; and road traffic accidents (RTA), 56.9% (n=29); falls, 29.4% (n=15); blunt trauma, 9.8% (n=5); and assaults, 3.9% (n=2); were the causes of the injuries. Of the 51patients, 52.9% (n=27) had cervical fractures, 20% (n=10) had lumbar fractures and 17% (n=9) and 10% (n=5) had lesions xii located at the thoraco-lumbar junction and thoracic spine respectively. Injury types identified were dislocations, 29.4% (n=15), wedge compression fractures, 25.5% (n=13), burst fractures, 25.5% (n=13), fracture dislocations, 17.6% (n=9), and chance fractures, 2% (n=1). 52% (n=27) of the patients underwent surgical decompression and instrumentation, 23.5% (n=12) and 9.8% (n=5) were managed by bracing (TLSO, cervical colar) respectively; and 13.7% (n=7) of the patients were managed by traction. Mortality rate was 7.8% (n=4); 41.2% (n=21) had residual neurological deficits at the end of the study and 31.4% (n=16) had motor functional recovery. 19.6% (n=10) were initially intact; ASIA impairment scale E. CONCLUSIONS Spinal cord trauma affects mainly young men. RTA, cervical spine fractures, distractive and multidirectional mechanisms of injury, dislocations and fracture dislocations with three columns spinal instability, and ASIA impairment scale A, were the commonest findings in the majority of the patients. Surgical intervention was the common treatment modality used. We need to increase awareness among young men; have high index of suspicion for cervical spinal injury, improvement on the management of patients with respiratory failure should be emphasized to decrease the morbidity and mortality associated with SCIs.