Median Sternotomy as a Useful Adjunct to Anterior Cervicothoracic Spine Decompression and Fixation: A Plea for Its Popularity among Spine Surgeons in West Africa.

Direct anterior approach to the cervicothoracic spine (C7-T4) for surgery can be challenging via a standard anterior cervical incision as a result of the important neurovascular structures crowding the cervicothoracic junction. Where indicated, median sternotomy provides improved access to this region of the spine for interventions. From the paucity of published literature in West Africa, this adjunct appears to be quite unpopular among spine surgeons in our sub-region. We report the presentation, preoperative evaluation, operative technique and outcome of treatment of a 66-year-old man with multiple myeloma affecting T1 with the same vertebral body collapse, who had full median sternotomy, anterior T1 decompression with C7-T2 Spinal fixation. Where indicated, an anterior trans-sternal approach to the cervicothoracic spine offers good exposure to T2/T3 vertebral body for decompression and instrumentation with minimal risks and morbidity. Spine surgeons in the West African subregion should utilize this important collaboration with thoracic surgeons to achieve satisfactory access to spine surgery within the thoracic cavity.

Severity and Predictors of Outcome of Motorcycle-Associated Head Injury: An Experience from a Regional Neurosurgery Centre in Northern Nigeria.

BACKGROUND: Motorcycle-associated head injury is one of the leading causes of disability and deaths, with its main victims being the motorcyclists, passengers, and pedestrians in their young productive age group. This study determines the role of severity and some predictive factors on survival and mortality of motorcycle-associated head injury. METHODS: This is a cross-sectional study using data of patients managed for motorcycle-associated head injuries between December 2014 and November 2016. The patients' biodata, clinical findings, and management outcomes were analyzed using Statistical Packages for the Social Sciences version 20. RESULTS: A total of 184 patients were analyzed, most of whom (81%) were aged ≤40 years and with a male dominance of 6.7:1. Pupillary abnormality was seen in 43.5% of the patients, and severe head injury occurred in 34.2% of the patients. Hemorrhagic contusion was the most common computed tomography (CT) finding (16.3%). Among 20.8% of the patients who died, 63.2% had severe head injury. CONCLUSIONS: Motorcycle-associated head injury predominantly occurred among young men who used a motorcycle for commercial purposes. The survival rate was higher among patients who had brain CT scan performed, extra-axial clots, and operative treatment. However, high mortality was seen among patients who could not afford brain CT scan, and who had bilateral pupillary dilatation, CT findings of abnormalities that are not surgically amenable, and severe head injury.

Developing a Guideline for Neurotrauma in Nigeria.

BACKGROUND: The Nigerian Academy of Neurological Surgeons in 2019 resolved to standardize the practice of neurosurgery in Nigeria. It set up committees to standardize the various aspects of neurosurgery, such as neurotrauma, pediatrics, functional, vascular, skull base, brain tumor, and spine. The Committee on Neurotrauma convened and resolved to study most of the available protocols and guidelines in use in different parts of the world. OBJECTIVE: To formulate a standard protocol for the practice of neurotrauma care within the Nigerian locality. METHODS: The Committee split its membership into 3 subcommittees to cover the various aspects of the Neurotrauma Guidelines, such as neurotrauma curriculum, standard neurotrauma management protocols, and neurotrauma registry. Each subcommittee was to research on available models and formulate a draft for Nigerian neurotrauma. RESULTS: All the 3 subcommittees had their reports ready on schedule. Each concurred that neurotrauma is a major public health challenge in Nigeria. They produced 3 different drafts on the 3 thematic areas of the project. The subcommittees are: 1. Subcommittee on Fellowship, Training and Research Curriculum; 2. Subcommittee on Standard Protocols and Management Guidelines; and 3. Subcommittee of the Nigerian Neurotrauma Registry. CONCLUSION: The committee concluded that a formal protocol for neurotrauma care is long overdue in Nigeria for the standardization of all aspects of neurotrauma. It then recommended the adoption of these guidelines by all institutions offering services in Nigeria using the management protocols, opening a registry, and mounting researches on the various aspects of neurotrauma.