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 des anomalies significatives du rachis lombaire à la tomodensitométrie pour lombalgies chez 403 patients à Saint-Louis au Sénégal

Objectifs:dresser le profil étiologique à la tomodensitométrie desdouleurs lombaires chez 403 patients.Matériels et méthodes: il s'agissait d'une étude transversale à propos de 403 dossiers colligés sur une période de 15 mois au service d'Imagerie du Centre Hospitalier Régional de Saint-Louis du Sénégal. Tout patient adressé pour scanner lombaire a été inclus quel que soit son âge, son sexe ou son indication. Les patients dont le scanner était normal ont été exclus. Les examens étaient réalisés avec un scanner 16 coupes de type Siemens.Les paramètres étudiés étaient l'âge, le sexe, l'indication et les résultats de l'examen tomodensitométrique. Le recueil et l'analyse des données ont été effectuées à l'aide du tableau Excel 2010 et du logiciel SPSS 22. Le test exact de Fisher a été effectué et un seuil de signification &=5% a été fixé.Résultats: Lamoyenned'âge de la population d'étudeétaitde 45 ansavecdesextrêmesde 16 anset 89 ans et un genre ratio de 1,3. La tranched'âge de 31 ans ­ 40 ansétaitprédominante. Sur le plan clinique, 213 patients soit 52,9% étaient adressés au scanner pour douleurs lombaires non spécifiques contre 47,1% de cas pour sciatalgie. Parmi ces derniers les 21,3% présentaient une sciatalgie bilatérale, 14,4% avaient une sciatalgie droite tandis que 12,7% présentaient une symptomatologie à gauche.Une discopathie dégénérative était notée dans 92,3% des cas avec un conflit disco-radiculaire retrouvé chez 41,2% de ces patients.Une hernie discale était présente chez 93 patients (23%). Elle était latérale dans 46% des cas, médiane dans 45% et foraminale dans 9% des cas. Les atteintes arthrosiques étaient représentées par les spondylophytes (47,9%), l'érosion des plateaux vertébraux (9,2%) et le phénomène de vide discal (18,4%) La lyse isthmique était observée dans 9,4% des cas. Les troubles de la statique rachidienne étaient retrouvés chez 17% des patients et les anomalies transitionnelles chez 11,4% des patients avec sacralisation de L5 dans 7,2% et lombalisation de S1 dans 4,5%.Le canal lombaire étroit représentait 7%, les lésions traumatiques 5%, les lésions infectieuses 1,5% des cas, les lésions inflammatoires 2,7% et lésions d'allure tumorale 2,5%.Nous avions noté une dégénérescence graisseuse des muscles rachidiens chez 2,2% des patients.Conclusion: La majorité des patients adressés pour TDM lombaire est relativement jeune avec des étiologies dominées par les discopathies dégénératives. La TDM nous a permis de faire une analyse morphologique exhaustive et d'avoir une orientation étiologique de ces douleurs lombaires même si l'IRM reste l'examen de référence

Intrasound therapy: an effective alternative to sodium diclofenac phonophoresis in the management of mechanical chronic cervical spine pain

The efficacy of Sodium Diclofenac Phonophoresis (SDP) as an effective adjunct in the management of inflammation and pain has been established though its application entails complicated choices of treatment parameters. Intrasound Therapy (IST), acclaimed for its simplicity of operation has been reported to promote healing though no studies have been done on its effect in Chronic cervical spine pain (CCSP). The aim of this study was to determine if IST could be an effective therapeutic option to SDP as an adjunct in the management of CCSP. Forty seven (47) participants with CCSP that had definite diagnoses were randomly assigned into 3 groups. All participants had exercises and massage while in addition, group 1 had SDP and group 2 IST for 10 minutes each. Participants were treated for 40 minutes twice a week for 4 weeks and were evaluated for pain, Quality of life (QoL), disability and range of motion (ROM) of the cervical spine. Paired sample t-test was used to compare the outcome parameters in each group and data presented as Mean ± SEM with significance at p<0.05. IST and SDP significantly (p˂0.05) improved the clinical parametres compared with the control group and there were no significant (p ˃0.05) differences in clinical outcome between the IST and SDP groups. IST was as effective as SDP and considering its relative simplicity of operation could be an alternative therapeutic adjunct in the management of chronic cervical pain

Outcome of a posterior spinal fusion technique using spinous process wire and vertical strut

Background/Objective: Spinal fusion is a rapidly developing area of spine surgery. Many of the implants often used are not within the reach of the patients in the developing world. In this study; we describe the outcome of a novel technique of posterior spinal fusion using the rush nail and spinous process wire. Materials and Methods: We prospectively evaluated patients who underwent the technique since October 2006. We reviewed the patients' biodata; clinical diagnosis; imaging studies; indications for surgery; type of operations; and complications related to the implants and the technique. Clinical test of instability was also determined. Results: The technique was used in 11 female and 19 male patients. The age range was 11-82 years. The indication for surgery was trauma in 15 patients; degenerative disease in seven patients; tuberculosis of the spine in four patients; and four patients had neoplasms. Occipitocervical fusion was performed in three patients; cervical fusion in six patients; thoracic fusion in 10 patients; thoracolumbar fusion in seven patients; lumbar fusion in three patients; and lumbosacral fusion in one patient. The distal segment of the implant backed out in one patient following fracture of the spinal process. The implant was eventually removed. Clinical evidence of instability necessitating external orthotics was also seen in one patient. Two patients had wound infection. These were managed without removing the implants. We did not observe significant complications in other patients. Conclusion: The technique appears safe and effective in carefully selected cases. The technique needs further evaluation in a larger patient population and with a longer duration of follow-up

Gunshot injuries of the spine - a review of 49 cases managed at the Groote Schuur Acute Spinal Cord Injury Unit : trauma

The Acute Spinal Injury Unit; relocated from Conradie Hospital to Groote Schuur Hospital in mid-2003; admitted 162 patients in the first year of its existence. A large number of these injuries were the result of interpersonal violence; particularly gunshot wounds. Aim. To review patients with gunshot injuries to the spine; with reference to neurological injury; associated injuries; need for surgery and complications. Methods. A comprehensive database is maintained to collect data on all spinal injury admissions. These data; as well as case notes and X-rays; were reviewed for all gunshot spine patients admitted to the Acute Spinal Injury Unit over a year. Forty-nine patients were identified. Thirty-eight were male and 11 female with an average age of 27.5 years (range 15 - 51 + 8.53). The average stay in the acute unit was 30 (4 - 109 + 28) days. Results. The spinal injury was complete in 38 and incomplete in 8; with 3 having no neurological deficit. The level was cervical in 13; thoracic in 24 and lumbar in 12. Only 9 patients improved neurologically. The spine was considered stable in 43 cases. Stabilisation was performed in the 6 unstable cases. The bullets were removed in 11 cases as they were in the canal. There were 55 significant associated injuries; viz. 14 haemo-pneumothoraces; 16 abdominal visceral injuries; 3 vascular injuries; 4 injuries of the brachial plexus and 3 of the oesophagus; 2 tracheal injuries; 1 soft palate injury and 11 non-spinal fractures. Complications included 3 deaths and discitis in 3 cases; pneumonia in 6 and pressure sores in 6. Conclusion. Gunshot injuries of the spine are a prevalent and resource-intensive cause of paralysis. There is a high incidence of permanent severe neurological deficit; but usually the spine remains mechanically stable. Most of the management revolves around the associated injuries and consequences of the neurological deficit

Spinal African histoplasmosis simulating tuberculosis spondylitis

Spinal histoplasmosis is a rare disease condition that must be differentiated from other common inflammatory lesions of the spine such as tuberculosis. A case is presented of a pathologically proven African spinal histoplasmosis in a 39-year old female. Paraplegia and fever were the patient clinical findings. Cervical plain radiography demonstrated a lytic destructive process of the lower cervical spine with radiographic signs similar to tuberculosis. the surgical management and chemotherapy of histoplasmosis are briefly discussed

Spinal and Epidural Anaesthesia in a Rural Hospital

Spinal anaesthesia is a cheap; simple and safe form of anaesthesia where it is applicable and it should be more frequently and widely used in rural Ugandan hospitals