Management and outcome of traumatic spinal injury in a low resource Sub-Saharan African setting: A 5-year retrospective cohort study

Abstract

BACKGROUND: Traumatic spinal injury (TSI) is a devastating condition with a disproportionately high burden in low-resource settings. Data on its management and outcomes in semi-urban Cameroon is limited. OBJECTIVE: To describe and analyse the management and outcomes of TSI patients at the Buea Regional Hospital in Southwest Cameroon. METHODS: A retrospective review was conducted for all TSI patients admitted between 2017 and 2022. Data on patient management, complications, mortality, and functional neurological improvement were collected and analysed using inferential statistics and modelling to identify associated factors. RESULTS: 51 TSI patients aged 38.3±15.7 years were included. CT scan was the initial imaging in 63.7% of patients. Surgery was performed in 31.4% of cases, with a median time from injury to surgery of 31.0 (IQR: 13.0-41.1) days. In-hospital complication rate was 52.9% (95% CI: 38.6%, 66.8%), predominantly pressure ulcers and paralytic ileus (27.5% each). A multivariable model (Hosmer-Lemeshow P = 0.95; AUC=0.87) identified age >40 years (aOR=6.64) and delayed spine surgery (≥ 6 days post injury, aOR=84.8) as significant predictors of complications. Functional neurological improvement occurred in 27.9% (95% CI: 15.8%, 43.9%) of patients and was associated with non-cervical injuries (p = 0.03), specific initial Frankel grades A and C (p = 0.04), and administration of multi-vitamin/mineral medications (p = 0.007). The overall in-hospital mortality rate was 20.4% (95% CI: 10.7%, 34.8%), with higher mortality observed in patients over 40 (p = 0.03), those with cervical spine injuries (p = 0.004), and those presenting with urinary dysfunction (p = 0.04). CONCLUSION: TSI care in our setting is associated with high complication and mortality rates, especially among older patients and those with delayed spine surgery. These critical challenges in TSI care suggest a possible need for targeted interventions to improve timeliness of care and complication prevention to enhance overall patient outcomes in this resource-limited setting.