Aspects épidémiologiques, diagnostiques et thérapeutiques des traumatismes vertébro-médullaires au Centre Hospitalier Universitaire d'Owendo, Gabon / Spinal cord injury at the Owendo teaching hospital, Gabon. Epidemiology, diagnosis and management

Spinal cord injury constitutes a multidisciplinary therapeutic emergency. It occurs usually in a context of polytrauma. The aim of this study was to describe the management of spinal cord injury admitted to the emergency department of a "trauma center". Methods: This is a prospective observational study carried out at the University Hospital of Owendo, Gabon. Patients admitted to the emergency department of any age for spinal cord injury and having performed a radiological examination were included. Socio-demographic parameters, circumstances and times of onset of trauma, mode of transport, state of consciousness, sensory and motor deficit, American Spinal Injury Association (ASIA) Score, hemodynamic and respiratory status were assessed. Results: During the study period, 850 patients were registered at the emergency department. Among them 112 were admitted for spinal cord injury (3.17%). The average age of the patients was 36 ± 3 years. The male gender accounted for 77% of cases. It concerned in 36% of cases the unemployed. The road accident was incriminated in 61%. Pedestrians were involved in 81% of cases. The clinical evaluation on admission found a sensorimotor deficit in 45 patients (40.17%), there were 11 tetraplegias (10%) and 3 paraplegias (3%). The majority of patients (77.7%) were classified as Fränkel stage A. The lesions were dominated by dislocations of the cervical spine (30.4%). Specialized care was essentially orthopedic in 60.7%. No patient was operated. Conclusion: Spinal cord injuries are "time-dependent" medical and surgical emergencies. A codified organization of pre-hospital care and an efficient "trauma center" are essential factors for the management of this type of traumatic pathology

Profil clinique, thérapeutique et devenir des traumatismes vertèbro-médullaires aux Cliniques Universitaires de Kinshasa en République Démocratique du Congo / Clinical, therapeutic and outcome of vertebro medullary traumas at Kinshasa University Hospital, in the Democratic Republic of Congo

Les traumatismes vertébromédullaires (TVM) en Afrique subsaharienne sont très peu documentés. L'objectif de ce travail était de décrire les aspects cliniques, thérapeutiques et évolutifs de TVM. Méthodes. C'était une série analytique des cas de TVM soignés aux Cliniques Universitaires de Kinshasa (CUK) entre 2016 et 2022. Les variables d'intérêt englobaient les données cliniques, thérapeutiques, le score ASIA à l'admission et à la sortie, et le devenir. Nous avons recouru au test de Chi carré de Pearson pour comparer les proportions. Résultats. Sur les 123 patients opérés pour lésions vertébro-médullaires, 62 cas étaient traumatiques (50,4 %). Le sexe masculin était prépondérant (75,8 %). Leur âge moyen était de 36,0 ± 13,0 ans. Les accidents de la voie publique (74,2 %) en étaient la principale cause. A l'admission, il y avait 58,1% des paraplégiques et 21 % des tétraplégiques. Vingt-sept patients (43,5 %) ont été admis 1 à 2 mois après le traumatisme. Les patients classés ASIA A représentait 62,9 % des cas. Vingt traumatismes (32,3 %) ont siégé sur le rachis cervical inférieur et 25 (40,3%), à la charnière thoraco-lombaire. Au niveau cervical, 10 cas étaient classés Argenson B (16,1 %) et en thoraco-lombaire, il y avait 17 fractures Magerl A (27,4 %) et 22 Magerl B (35,5 %) avec 63,6 % d'antélisthésis. La laminectomie (59,8 %) et la corporectomie (25,8 %) avec fixation rachidienne étaient les procédures les plus pratiquées. Les suites opératoires étaient simples dans 68,4 %. Il y a eu 9 cas d'infection du site opératoire (14,5 %), 2 cas de fistules de LCS (3,2 %), 3 cas d'escarres (4,8 %) de décubitus et 5 décès (8,1%). Le score ASIA à la sortie était significativement amélioré par rapport à celui de départ dans 33,9 % de cas (p <0,001). Conclusion. Les traumatismes vertébro-médullaires consécutifs aux accidents de trafic routier demeurent des lésions assez fréquentes nécessitant un traitement chirurgical. Les jeunes de sexe masculin sont les plus touchés. Le déficit neurologique est souvent complet. La laminectomie ou la corporectomie suivies de la fixation rachidienne sont couramment réalisées avec une récupération neurologique satisfaisante dans un tiers de cas.

Drivers of cost of treatment for traumatic spinal cord injury in ibadan, Nigeria

Background:Traumatic Spinal Cord Injury (TSCI) is a costly condition in human and economic terms. Yet, studies on direct cost of treatment for TSCI in resource-constraint countries are sparse.Objective:To estimate the direct cost of treatment for patients with TSCI at the University College Hospital (UCH), Ibadan, Nigeria using an incidence-based costing approache Methods:All new cases of TSCI admitted in the hospital from January, 2009 to December, 2013 were identified and reviewed. Direct costs of in-patient and out-patient treatments over the first year of injury were estimated.Results:114 individuals with TSCI (73 males; 41 females) were admitted and discharged home alive from the hospital. The largest cost driver to the patients and the National Health Insurance Scheme was cost of consultations by neurosurgeons which constituted about a third (34.4%) of the total costs of treatment. Less than a fourth (24.2%) of the total cost of in-patient treatment was spent on therapeutic interventions (surgery, drugs and physiotherapy). There was a significant relationship between the direct cost of treatment and each of the severity of traumatic spinal cord injury and length of hospital stay (p = 0.01). Level of injury was not significantly associated with direct cost of treatment (p=0.89).Conclusion:Direct cost of treatment for individuals with TSCI in Ibadan, Nigeria is substantial. This high cost underscores the need for novel service models with potential for minimizing cost for patients with TSCI in Nigeria

Closed traction reduction of cervical spine facet dislocations: compelled by law

Background. Following a 2015 ruling, the South African (SA) Constitutional Court obligates closed reduction of cervical facet dislocations sustained through low-energy injury mechanisms, within 4 hours of injury. Closed traction reduction of cervical facet dislocations requires specific equipment and expertise, which have limited availability in SA.Objectives. To review the time delays, delaying factors and success rate of closed reductions of cervical facet dislocations in a tertiary-level orthopaedic department and training facility, and to consider the feasibility of such a reduction within 4 hours after injury.Methods. The clinical records and imaging screens of patients presenting with cervical facet dislocations to an academic training hospital between November 2008 and March 2016 were retrospectively reviewed, with specific attention to demographic information, mechanism of injury, time delays from injury to treatment and factors resulting in delay, as well as the success rate in closed cervical reduction.Results. Ninety-one patients with cervical dislocation presented during the study period, of whom 69 were included for further review. The mean age at presentation was 37.6 (range 18 - 65) years. Successful reduction was achieved in 71% (n=49) of cases, with a median delay time from injury to reduction of 26 (interquartile range (IQR) 19.50 - 31.75) hours. Only 1 patient of 69 patients received successful reduction within 6 hours after injury. Neurological improvement was noticed in 5 of 53 patients with neurological deficit ­ after successful reduction. Two patients improved with two American Spinal Injury Association (ASIA) grades (from A to C), and 2 improved with one ASIA grade (from A to B and D to E).Conclusions. Successful reduction of a cervical facet dislocation within 4 hours presents a challenge to healthcare infrastructure globally. The relative scarcity of this type of injury (91 cases during 8 years in a tertiary referral hospital) prevents district-level clinicians from readily acquiring a level of experience to confidently perform closed reduction of these injuries, unless very specific training and support are provided towards this end

Stem cell tourism and spinal cord injury in South Africa

Background. The publicity around stem cell therapy has given many persons who have sustained a devastating injury such as spinal cord injury (SCI) the hope of achieving partial or full recovery from their injuries. Several phase I and II clinical trials are being conducted owing to positive results obtained in animal models. While safety during the trials has been demonstrated, clinical efficacy in the outcome of ethically approved trials is still lacking. Many persons affected by SCI are, however, desperate for a cure and are lured into undergoing stem cell therapy by marketing campaigns and information readily available on the internet. These people travel far and wide to undergo stem cell therapy, which has led to the term 'stem cell tourism'. Objectives. To compare the data from participants' self-report questionnaires before and after their stem cell therapy to determine if there were differences in their functional and neurological status, and to record details of the procedures. Method. Persons who sustained a SCI and who received apparent stem cell therapy in South Africa (SA) or elsewhere were recruited to participate in the present study. Volunteers who gave written informed consent were asked to complete a biographical questionnaire and validated self-report questionnaire (Spinal Cord Independence Measure version III (SCIM III)) before and after their stem cell therapy to determine if there were differences in their functional and neurological status. The results of the self-report questionnaires were compared with the published expected functional outcome of people with lesions at a similar level of SCI to the participants. The secondary aims of the study were to document details of the procedures and their locations, the sources of 'stem cells' and the cost. Results. There was no indication that the participants' functional outcomes, as measured by the self-reported SCIM III, were better than the expected level of functional ability in patients with similar injury levels. Likewise, the neurological motor recovery scored on the International Standards for the Neurological Classification of Spinal Cord Injury (ISNCSCI) motor scores showed no improvement post stem cell therapy. Conclusion. This study highlights the need to curb the practice of offering unethical and non-evidence-based stem cell therapy for SCI. Ethical research and treatment is encouraged as well as an effective legal framework and education of health professionals, patients and their family members and caregivers, which will avoid unrealistic expectations, bogus therapies and the potential adverse effects of non-evidence-based 'stem cell therapies' offered by clinics via the internet

Morbidity and mortality associated with conservative management of spinal cord injury in Makurdi, north central Nigeria

Background Spinal cord injury is commonly associated with morbidity and mortality. This is further worsened by inadequate rehabilitation because of dearth of infrastructure, equipment and personnel Objectives:To identify the complications and causes of death in traumatic spinal cord injury patients.Methodology: A 4-year retrospective review of all traumatic spinal cord injured patients treated at Benue State University Teaching Hospital Makurdi was conducted. The information on age, sex, occupation, cause, associated injuries, level of injury, neurological deficit, American spinal cord injury association (ASIA) score at presentation, complications and outcome were obtained from medical records department. Data were analyzed using Statistical Package for Social Sciences (SPSS) 17.0 (SPSS Inc. Chicago, IL, USA).Results: There were 62 patients with a mean age of 36.02±1.67 years (range 8-77 years) consisting of 54 males and 8 females giving a male to female ratio of 6.8:1. They included students 13(21%) and farmers 10(16.1%). Road traffic crash accounted for 35(56.5%). Majority had cervical spine injury 22(62.8%) and accounted for complications in 20(36.4%). Bed sores occurred in 22(35.5%). ASIA A had the highest frequency of complications 22(35.5%). Eleven patients died giving a case fatality of 31.4%. The patients died from respiratory failure 4(36.4%) and sepsis 2(18.2%). Conclusion: Many complications including bed sores and orthostatic pneumonia result from spinal cord injury leading to high morbidity and death from sepsis and respiratory failure

Patterns of Spinal Injury in a New Neurosurgical Centre: A 2-Year Prospective Study

Background: Spinal injury is a major cause of morbidity and mortality worldwide. Road traffic accident is the main aetiologic factor; affecting mostly the male gender in the 15 - 40-year age group. The aim of this study was to establish our local hospital patterns of spinal injury and compare them with published reports. Methods and Patients: A prospective study of all spinal injury patients treated in our service in the two-year period; April 21; 2006 - April 20; 2008 was undertaken. Data collection was done using a structured proforma from the time of admission into our service to the time of discharge; and subsequent follow-up in the few cases that kept to their appointment. Data was then collated and simple data analysis done. Results: Spinal injury was diagnosed in 62 of our 826 patients; mostly males; aged 15-40years 28 (45.2); and road traffic accident was the main aetiologic factor with an unusually high case incidence from motorcycles. There were neurological deficits in 49(79) and cervical cord injuries were the most common. Evaluation of the injuries was mostly with plain radiography; and treatment was non-operative in all cases. omplete cord injuries remained without improvement; and complications were mostly pressure ulcers; with no incident of deep venous thrombosis. Mortality was 13(21). Conclusion: Spinal injury was an important indication for neurosurgical consultations in our service. Complete cord injuries were more common than incomplete injuries contrary to other previous reports; and the case incidence from motorcycles was remarkably high

Management of penetrating spinal cord injuries in a non spinal centre: experience at Enugu, Nigeria

BACKGROUND:Penetrating injuries of the spinal cord are among the most dangerous of injuries. They are often associated with injuries to other vital organs of the body, which may demand priority attention. The objectives of this study were to determine the pattern of the penetrating spinal cord injuries and to evaluate outcome of treatment in our setting.METHODS:This is a retrospective study of all penetrating spinal cord injuries seen at the National Orthopaedic Hospital, Enugu over a fifteen-year period (April 1990 March 2005). Information about the demographics aetiology, level of injury, associated injuries, time of presentation, duration of hospitalization and outcome of treatment were retrieved from patients case notes. Data were analyzed using SPSS for windows version 11.RESULT: There were 22 patients, 13 males and 9 females, giving a M:F ratio of 1.7:1. Gunshot injury was the most common aetiological factor. The thoracic spine {9 (41%)} was most often involved. Chest and abdominal injuries were common associated injuries in 5 cases. The circumstances of the injury were mostly armed robbery attack {13 (59%)}. On admission the neurological status was Frankel grade A in 20(91%) cases. Period of hospitalization ranged from 1 week to 36 weeks with a mean of 11 weeks. Pressure sore was the most common complication that delayed rehabilitation. Five (23%) patients with injury at cervical level died from respiratory failure.CONCLUSION:Penetrating spinal cord injuries are relatively rare and demand extra care. Early recognition of associated injuries, minimal wound excision and antibiotic therapy give good result

Effect of clean intermittent catherization on lower urinary tract : an experimental study

Objective To investigate the effect of clean intermittent catheterization (CIC) on the lower urinary tract in experimental animals. Patients and Methods: Eight male spinalized cats were subjected to CIC for a period of 6 - 9 weeks. A urine specimen for culture was obtained weekly. A pathological examination of the proximal and distal urethra and the bladder was performed. Results Urinary tract infection was detected in all cats starting from the second week. It responded to antibiotics but recurrence occurred after discontinuing the treatment. One animal died in the 4th week from fibrinopurulent peritonitis caused by necrotizeng ulcerative cystitis. False passage occurred in another cat at the end of the 6th week. It was managed by fixation of a urethral catheter for a week; and CIC was then continued for another two weeks. Pathological examination showed a thickening of the urethral wall that progressed with the duration of CIC. Microscopic examination of the urethra showed epithelial hyperaemia; ulceration and an inflammatory reaction with oedema as well as an inflammatory reaction of the lamina propria. The muscular layer showed progressive hypertrophy with continuing CIC. The bladder wall showed epithelial ulceration; Brunn nests and squamous metaplasia with islands of degenerated cells. Conclusion Recurrent urinary tract infection; local traumatic reactions of the urethral and bladder wall; especially epithelial damage of the mucosa; and false passages are common complications occurring with CIC in the experimental animal. Although the situation in the experimental animal has no relevance in humans; yet; it may throw light on some aspects of possible complications of long-term CIC

Central somatosensory conduction in normal Nigerians and patients with spinal cord disorders

Spinal and scalp somatosensory evoked potentials obtained by tibial nerve stimulation were recorded in 24 normal adult Nigerians and 11 patients with non-traumatic spinal cord disorders. The morphology and means of latencies of the major somatosensory evoked potential (SEP) components in the normal subjects (N21: 22.6 + 1.4 msec; P40: 39.1 + 2.5 msec; N50: 48.3 + 2.3 msec and P60: 62.4 + 3.9 msec) were similar to those reported in other populations. Seven of the 11 patients had abnormal central somatosensory conduction (CSC) as judged by a weighted scoring scheme. This was abnormal in all four patients with impaired proprioception and in three of seven patients with normal proprioception. This preliminary report shows that SEP studies are useful in detecting sub-clinical posterior column dysfunction in Nigerian patients with spinal cord disorders and the severity of this could be graded with the CSC scoring scheme