Pattern and Outcome of Management for Traumatic Closed Cervical Spine Injuries at The National Orthopaedic Hospital, Enugu, Nigeria.

Abstract

Background: The cervical spine is an area quite prone to trauma due to its mobile character. It is placed under various significant demands during various physical activities which predispose it to various injuries. The knowledge and good understanding of the common patterns of cervical spine injuries and their mechanisms will facilitate accurate assessment, diagnoses and prompt appropriate decisions about specific management. The main thrust of the application of epidemiologic methods to the study of spinal injuries is aimed at identifying injury trends and correlating these trends with definite risk factors and preventive strategies. The aim of the study is to determine the pattern and early outcome of management of closed cervical spine injuries at Enugu.
Methods: A retrospective study was done in which the records of 132 patients admitted for closed cervical spine injuries over a ten year period were analyzed and the following data extracted: demographic indices, mechanism of injury, spinal level of injury, type of vertebral injury, complications, duration of stay in hospital, nature and level of cord injury, residual morbidity at discharge, and duration of follow-up visits.
Results: The age of the patients ranged from 5 - 80 years with a mean of 37 years. More males were involved (93.9%) than females (6.1%). The commonest mechanism of injury is road traffic accidents (66.7%) and the most frequently involved segment is the C6/C7. Fracture subluxation of C6 on C7 occurred in 27.3% of cases. 75.8% of cases had complete cord injury while 24.2% had incomplete lesions. Pressure sores and urinary tract infection were the commonest complications seen in 29.5% and 24.4% respectively. The length of hospital stay for the majority of the patients (47%) was between 4 weeks and 12 weeks. At discharge, 56% of all the patients were wheel chair bound, 22.7% were mobilizing with walking aids and death occurred in 21.2%, mostly high cervical cord injured patients. 93.6% of the patients with incomplete cord injury were mobilizing with walking aids at the point of discharge. 60% and 75% of the patients were lost to fellowup at one and two years respectively.
Conclusion: Lower cervical spine fracture subluxation is the commonest site of cervical spine injury in our environment. Complete cord injury is commoner than incomplete cord injury. The commonest complications in our environment are pressure sores and urinary tract infection. Prevention of these injuries remains the best  management option.

Key Words: cervical spine injury, pattern, outcome, Nigeria.