Spinal trauma in Tanzania: current management and outcomes

Restricted access

OBJECTIVE

Spinal trauma is a major cause of disability worldwide. The burden is especially severe in low-income countries, where hospital infrastructure is poor, resources are limited, and the volume of cases is high. Currently, there are no reliable data available on incidence, management, and outcomes of spinal trauma in East Africa. The main objective of this study was to describe, for the first time, the demographics, management, costs of surgery and implants, treatment decision factors, and outcomes of patients with spine trauma in Tanzania.

METHODS

The authors retrospectively reviewed prospectively collected data on spinal trauma patients in the single surgical referral center in Tanzania (Muhimbili Orthopaedic Institute [MOI]) from October 2016 to December 2017. They collected general demographics and the following information: distance from site of trauma to the center, American Spinal Injury Association Impairment Scale (AIS), time to surgery, steroid use, and mechanism of trauma and AOSpine classification and costs. Surgical details and complications were recorded. Primary outcome was neurological status on discharge. The authors analyzed surgical outcome and determined predicting factors for positive outcome.

RESULTS

A total of 180 patients were included and analyzed in this study. The mean distance from site of trauma to MOI was 278.0 km, and the time to admission was on average 5.9 days after trauma. Young males were primarily affected (82.8% males, average age 35.7 years). On admission, 47.2% of patients presented with AIS grade A. Most common mechanisms of injury were motor vehicle accidents (28.9%) and falls from height (32.8%). Forty percent of admitted patients underwent surgery. The mean time to surgery was 33.2 days; 21.4% of patients who underwent surgery improved in AIS grade at discharge (p = 0.030). Overall, the only factor associated with improvement in neurological status was undergoing surgery (p = 0.03) and shorter time to surgery (p = 0.02).

CONCLUSIONS

This is the first study to describe the management and outcomes of spinal trauma in East Africa. Due to the lack of referral hospitals, patients are admitted late after trauma, often with severe neurological deficit. Surgery is performed but generally late in the course of hospital stay. The decision to perform surgery and timing are heavily influenced by the availability of implants and economic factors such as insurance status. Patients with incomplete deficits who may benefit most from surgery are not prioritized. The authors’ results suggest that surgery may have a positive impact on patient outcome. Further studies with a larger sample size are needed to confirm our results. These results provide strong support to implement evidence-based protocols for the management of spinal trauma.

ABBREVIATIONS AIS = American Spinal Injury Association Impairment Scale; GDP = gross domestic product; LMICs = low- and middle-income countries; LOS = length of stay; MOI = Muhimbili Orthopaedic Institute; MVA = motor vehicle accident; SCI = spinal cord injury; ST = spinal trauma.

Article Information

Correspondence Roger Härtl: Weill Cornell Brain and Spine Center, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, NY. roger@hartlmd.net.

INCLUDE WHEN CITING Published online April 5, 2019; DOI: 10.3171/2018.12.SPINE18635.

A.L. and E.E.K. contributed equally to this work.

Disclosures Dr. Härtl: consulting fees from AOSpine, Brainlab, DePuy Synthes, and Lanx.

This publication will be included in the PhD dissertation of Andreas Leidinger, MD, at Universidad Autónoma de Barcelona, Barcelona, Spain.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Geographical and chronological information from trauma to treatment. A: Geographical distribution of trauma sites of the patients in our sample. Circles are proportional to the number of patients. Radial proximity to the hospital is denoted by color gradients. B: Mean delay in number of days at different time points posttrauma. C: Tabulation of values in panel B. Range is reported in parentheses. Map data from Google Maps, accessed May 31, 2018. Figure is available in color online only.

  • View in gallery

    Venn diagram showing number of patients by type of imaging done. Two patients did not undergo imaging.

  • View in gallery

    AIS outcome grades of surgical patients and nonsurgical patients. Figure is available in color online only.

References

  • 1

    Ametefe MKBankah PEYankey KPAkoto HJanney DDakurah TK: Spinal cord and spine trauma in a large teaching hospital in Ghana. Spinal Cord 54:116411682016

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2

    Biluts HAbebe MLaeke TTirsit ABelete A: Pattern of spine and spinal cord injuries in Tikur Anbessa Hospital, Ethiopia. Ethiop Med J 53:75822015

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Cripps RALee BBWing PWeerts EMackay JBrown D: A global map for traumatic spinal cord injury epidemiology: towards a living data repository for injury prevention. Spinal Cord 49:4935012011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Draulans NKiekens CRoels EPeers K: Etiology of spinal cord injuries in Sub-Saharan Africa. Spinal Cord 49:114811542011

  • 5

    Edsberg LEBlack JMGoldberg MMcNichol LMoore LSieggreen M: Revised National Pressure Ulcer Advisory Panel Pressure Injury Staging System: Revised Pressure Injury Staging System. J Wound Ostomy Continence Nurs 43:5855972016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Hart CWilliams E: Epidemiology of spinal cord injuries: a reflection of changes in South African society. Paraplegia 32:7097141994

  • 7

    Igun GOObekpa OPUgwu BTNwadiaro HC: Spinal injuries in the Plateau State, Nigeria. East Afr Med J 76:75791999

  • 8

    Joseph CDelcarme AVlok IWahman KPhillips JNilsson Wikmar L: Incidence and aetiology of traumatic spinal cord injury in Cape Town, South Africa: a prospective, population-based study. Spinal Cord 53:6926962015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Lehre MAEriksen LMTirsit ABekele SPetros SPark KB: Outcome in patients undergoing surgery for spinal injury in an Ethiopian hospital. J Neurosurg Spine 23:7727792015

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10

    Levy LFMakarawo SMadzivire DBhebhe EVerbeek NParry O: Problems, struggles and some success with spinal cord injury in Zimbabwe. Spinal Cord 36:2132181998

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Moshi HSundelin GSahlen KGSörlin A: Traumatic spinal cord injury in the north-east Tanzania—describing incidence, etiology and clinical outcomes retrospectively. Glob Health Action 10:13556042017

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    National Bureau of Statistics (Tanzania): Employment and Labour Census 2012. Dar es Salaam Tanzania: National Bureau of Statistics Ministry of Finances 2013 (http://www.nbs.go.tz/) [Accessed January 18 2019]

    • Export Citation
  • 13

    Nwankwo OEUche EO: Epidemiological and treatment profiles of spinal cord injury in southeast Nigeria. Spinal Cord 51:4484522013

  • 14

    Nyberger KJumbam DTDahm JMaongezi SMakuwani AKapologwe NA: The situation of safe surgery and anaesthesia in Tanzania: a systematic review. World J Surg 43:24352019

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Ojo OAPoluyi EOOwolabi BSKanu OOPopoola MO: Surgical decompression for traumatic spinal cord injury in a tertiary center. Niger J Clin Pract 20:145514602017

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16

    Parizel PMvan der Zijden TGaudino SSpaepen MVoormolen MHVenstermans C: Trauma of the spine and spinal cord: imaging strategies. Eur Spine J 19 (Suppl 1):S8S172010

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17

    Rajan D: Situational analysis of the health sector in Schmets GRajan D (eds): Strategizing National Health in the 21st Century: A Handbook. Geneva: World Health Organization2016 (http://www.who.int/healthsystems/publications/nhpsp-handbook-ch3/en/) [Accessed January 18 2019]

    • Search Google Scholar
    • Export Citation
  • 18

    Rashid SMJusabani MAMandari FNDekker MCJ: The characteristics of traumatic spinal cord injuries at a referral hospital in Northern Tanzania. Spinal Cord Ser Cases 3:170212017

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19

    Sangowawa AOOwoaje ETEkanem SEFaseru BAdekunle BJ: Economic costs of motorcycle injury among crash-involved commercial motorcyclists in Oyo State, Nigeria. Afr J Med Med Sci 40:3853912011

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Silberstein MTress BMHennessy O: A comparison between M.R.I. and C.T. in acute spinal trauma. Australas Radiol 36:1921971992

  • 21

    Umaru HAhidjo A: Pattern of spinal cord injury in Maiduguri, North Eastern Nigeria. Niger J Med 14:2762782005

  • 22

    Velmahos GCDegiannis EHart KSouter ISaadia R: Changing profiles in spinal cord injuries and risk factors influencing recovery after penetrating injuries. J Trauma 38:3343371995

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Wesson HKBoikhutso NBachani AMHofman KJHyder AA: The cost of injury and trauma care in low- and middle-income countries: a review of economic evidence. Health Policy Plan 29:7958082014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    Winkler ASTluway ASlottje DSchmutzhard EHärtl R: The pattern of neurosurgical disorders in rural northern Tanzania: a prospective hospital-based study. World Neurosurg 73:2642692010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25

    The World Factbook (USA): Tanzania. Washington, DC: Central Intelligence Agency2018 (https://www.cia.gov/library/publications/the-world-factbook/geos/print_tz.html) [Accessed January 18 2019]

    • Export Citation

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 33 33 33
Full Text Views 9 9 9
PDF Downloads 27 27 27
EPUB Downloads 0 0 0

PubMed

Google Scholar