PATTERN AND OUTCOME OF CERVICAL SPINE INJURY

Abstract

ABSTRACT Background: Cervical spine injury is a common problem with a wide range of severity from minor ligamentous injury to frank osteo-ligamentous instability with spinal cord injury (1). The most common causes of cervical spine injury are automobile accidents, followed by diving into shallow water, firearm injuries, and sports activities (2). And in elderly group of people low energy fall from a standing height and high energy motor collisions are a common cause of c spine injury (3). Patients with complete cervical injuries had high rates of mortality and morbidity but there is a moderate recovery rate in patients with incomplete SCI despite a lack of adequate rehabilitation facilities (5) In developing countries like Ethiopia, little is known about the prevalence of cervical spinal injuries. An understanding of the prevalence of spinal injury is very important to develop possible preventive strategies and improve our primary trauma care. In addition, it helps to identify the risk factors and causes of spinal trauma thus helping to formulate preventive measures. Objective: To assess the pattern, outcome and associated factors of patients with C-spine injury visited AaBET Hospital ED from January 2018 to December 2022, Addis Ababa. Methods and Results: Institution based cross sectional study was conducted at AaBET hospital, Addis Ababa, Ethiopia. The study included patients presented to the emergency department with a diagnosis of cervical spine injury during a period of January 1, 2018 to November 1, 2023. A total duration of 5 years and 10 months. Data was collected by structured data extraction format from patient’s chart and analyzed by SPSS version 25.0. Descriptive analysis was used for statistical analysis of baseline data, and regression analysis was used to determine associations between dependent and independent variables. A p-value <0.05 was considered significant. Tables and figures were used to present the results. A total data of 149 patients were analyzed, with an average age of 36.3 ± 14.9 years (ranges 9-85 years) and the male to female ratio was 2.9:1. The most common mechanism of cervical spine injury is Road traffic accident (49.7, followed by falling down accident (39.6%) of patients. Seventy eight (52.3%) patients sustained a total of 114 associated injuries (ASOI). Head injury was the common associated injury followed by chest and extremity injury. The most frequently injured cervical vertebra was C 7 followed by C6 and T1. And 68.5% of the patient has multilevel injury. 33.6% of patients has neurological impairment ASIA class A followed ASIA class E (29.5%). The overall hospital mortality is 7.4%. The level of cervical spine injury, the ASIA class of the patient and the presence of associated injury were strongly associated for mortality. The median length of hospital stay was 6 days (IQR 18). And 30.2% of patients has prolonged length of hospital stay (PLOS). Neurosurgical intervention and the presence of associated injury particularly strongly associated with PLOS. Conclusion: This study showed the common mechanism was RTA and C7 was the common injury level. C3 injury level, ASIA A neurologic deficit and having associated injury were associated with mortality. Undergoing neurosurgical intervention and the presence of associated injury were associated with prolonged length of hospital stay (PLOS). Key words: Cervical spine, pattern, outcome, associated factor