Spinal injuries: experience of a local neurosurgical centre

ABSTRACT

To find out the pattern of traumatic spinal injuries and their management in patients admitted to a neurosurgical unit of a tertiary care hospital in a developing country. All patients admitted with spinal injuries between July, 2003 and June, 2007, in the Department of Neurosurgery, Civil Hospital, Karachi, were included. Information was recorded and analysed with respect to demographic data, mechanism of injury, level of bony injury, neurological degree [complete, incomplete and intact], duration between injury and admission, associated injuries, management, hospital stay and outcome. A total of 214 patients were admitted. These included 189 males [88.3%] and 25 females [11.7%]. Most affected patients [72/214 - 33.6%] were in their third decade of life, followed by second and fourth decades, 38 /214 [17.7%] in each decade. The commonest cause of injury was fall from height in 122 patients, [57.0%], followed by fall while carrying weight in 23 [10.7%], road accidents in 50 [23.4%] and gunshot injuries in 10 [4.7%] cases. Cervical spine was affected in the majority 101 [47.2%] cases followed by thoracic spinal injury, 64 cases and lumbar spine with 59 cases [27.6%]. Seventy seven patients [36%] had complete neurological loss, 119 [55.6%] had partial deficit while 18 patients [8.4%] were neurologically intact. Surgery [decompression and fixation] was performed in 50 cases. Long bone fracture was the commonest associated injury. The average time between injury and admission was 6.2 days [range 0-60]. Mean hospital stay was 8.4 +/- 7.6 days. Twenty three [10.7%] patients died during hospitalization. This study shows that young adults, predominantly males in their most productive years of life, are especially prone to spinal cord injury. Fall from height is the most common preventable cause of spinal injury. Recognizing the pattern of spinal injury helps to identify high-risk groups which will then help us to design more appropriate preventive measures: