Outcomes after acute traumatic spinal cord injury in Botswana: from admission to discharge

Löfvenmark, Inka; Hasselberg, Marie; Wikmar, Lena Nilsson; Hultling, Claes; Norrbrink, Cecilia

doi:10.1038/sc.2016.122

Cited by 12 publications

(14 citation statements)

References 17 publications

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“…In Nigeria, Nwankwo et al 20 reported neurologic improvement in 53% of patients undergoing surgery; however, they operated on only 1 ASIA A patient (6%) compared to 48% in our series. Similar to our results, Lofven et al 8 from Botswana reported an ASIA improvement rate of 16%. While a large study from Iran of 431 TSI patients reported early surgery (<48 hours) in 41% of patients, rates of neurologic improvement were unfortunately not included.…”

Section: Neurologic Outcomessupporting

confidence: 92%

“…The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. .303 21 24 .591 7 (6-12) 8 (7)(8)(9)(10)(11)(12)(13)(14) .193 33 40 .277…”

Section: Declaration Of Conflicting Interestsmentioning

confidence: 99%

“…Despite improvements in TSI management, resource-constrained settings have not yet benefitted from this progress to the same extent as more developed countries. [6][7][8] Although neurosurgery has been developing in East Africa since the 1940s, it remains tertiary and expensive. 9 Both stabilization techniques and time to surgery for spinal trauma are largely unreported.…”

Section: Introductionmentioning

confidence: 99%

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Operative Treatment of Traumatic Spinal Injuries in Tanzania: Surgical Management, Neurologic Outcomes, and Time to Surgery

Magogo

Lazaro

Mango

et al. 2020

Global Spine Journal

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Study Design: Retrospective case series. Objective: Little is known about operative management of traumatic spinal injuries (TSI) in low- and middle-income countries (LMIC). In patients undergoing surgery for TSI in Tanzania, we sought to (1) determine factors involved in the operative decision-making process, specifically implant availability and surgical judgment; (2) report neurologic outcomes; and (3) evaluate time to surgery. Methods: All patients from October 2016 to June 2019 who presented with TSI and underwent surgical stabilization. Fracture type, operation, neurologic status, and time-to-care was collected. Results: Ninety-seven patients underwent operative stabilization, 23 (24%) cervical and 74 (77%) thoracic/lumbar. Cervical operations included 4 (17%) anterior cervical discectomy and fusion with plate, 7 (30%) anterior cervical corpectomy with tricortical iliac crest graft and plate, and 12 (52%) posterior cervical laminectomy and fusion with lateral mass screws. All 74 (100%) of thoracic/lumbar fractures were treated with posterolateral pedicle screws. Short-segment fixation was used in 86%, and constructs often ended at an injured (61%) or junctional (62%) level. Sixteen (17%) patients improved at least 1 ASIA grade. The sole predictor of neurologic improvement was faster time from admission to surgery (odds ratio = 1.04, P = .011, 95%CI = 1.01-1.07). Median (range) time in days included: injury to admission 2 (0-29), admission to operating room 23 (0-81), and operating room to discharge 8 (2-31). Conclusions: In a cohort of LMIC patients with TSI undergoing stabilization, the principle driver of operative decision making was cost of implants. Faster time from admission to surgery was associated with neurologic improvement, yet significant delays to surgery were seen due to patients’ inability to pay for implants. Several themes for improvement emerged: early surgery, implant availability, prehospital transfer, and long-term follow-up.

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Section: Neurologic Outcomessupporting

confidence: 92%

Section: Declaration Of Conflicting Interestsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Operative Treatment of Traumatic Spinal Injuries in Tanzania: Surgical Management, Neurologic Outcomes, and Time to Surgery

Magogo

Lazaro

Mango

et al. 2020

Global Spine Journal

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“…Löfvenmark et al found that complete SCI was a strong dbidity, similarly Aarabi et al found that motor score of < 25 and ASIA A injury were strong predictors of morbidity which is also in keeping with the finding in this study. 6 32…”

Section: Discussionmentioning

confidence: 99%

“…Secondary injury to the traumatized cord is best prevented or minimized by adequate prehospital care, specialized acute treatment, and comprehensive rehabilitation facilitated by proper funding and health insurance. 6 7 8 Early access to specialized care after acute TSCI is associated with improved outcomes. 9 10 Patients who are admitted to specialist spinal care units within 24 hours of injury had fewer secondary complications.…”

Section: Introductionmentioning

confidence: 99%

Clinical Characteristics and Challenges of Management of Traumatic Spinal Cord Injury in a Trauma Center of a Developing Country

Yusuf

Mahmud

Alfin

et al. 2019

Journal of Neurosciences in Rural Practice

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Background Traumatic spinal cord injury (TSCI) is a major burden in trauma care worldwide. Most victims are young, and the injury results in economic loss and psychological and social burden on the individual and the society. The outcome depends on the severity of primary spinal cord injury, interventions to prevent secondary insults to the damaged cord, and access to a specialized care. The lack of standard prehospital care and dedicated facilities for spine care coupled with challenges of inadequate health insurance coverage impact negatively on the outcome of care in patients with spinal cord injury in our practice. Objectives This study was performed to determine the clinical profile of patients with TSCI and to highlight the factors that determine the early outcome in a resource-constrained trauma center. Materials and Methods This study was a retrospective review of trauma registry and medical records of all the patients with acute TSCI at the National Trauma Center Abuja from September 2014 to December 2016. Results A total of 133 patients with TSCI were studied. Most of these patients were young men with a mean age of 36 years. Most injury (72.2%) occurred following motor vehicular crash affecting mainly the cervical spinal cord (62.0%). None of the patients received standard prehospital care. Only 41.4% of the patients were transported to the hospital in an ambulance. About half (52.6%) of the patients suffered complete spinal cord injury (the American Spinal Injury Association [ASIA] A), and pressure ulcer was the most common complication (23.3%). Only 42% of the patients that needed surgical intervention were operated, mainly due to the inability to pay for the service. The ASIA grade on admission was the most significant determinant factor of morbidity and mortality. Conclusion Optimal care of patients with TSCI was hindered by inadequate facilities and economic constraints.

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Burden of Traumatic Spinal Cord Injury in Sub-Saharan Africa: A Scoping Review

Jesuyajolu,

Ayantayo,

Oyesiji

et al. 2023

World Neurosurgery

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Outcomes after acute traumatic spinal cord injury in Botswana: from admission to discharge

Cited by 12 publications

References 17 publications

Operative Treatment of Traumatic Spinal Injuries in Tanzania: Surgical Management, Neurologic Outcomes, and Time to Surgery

Operative Treatment of Traumatic Spinal Injuries in Tanzania: Surgical Management, Neurologic Outcomes, and Time to Surgery

Clinical Characteristics and Challenges of Management of Traumatic Spinal Cord Injury in a Trauma Center of a Developing Country

Burden of Traumatic Spinal Cord Injury in Sub-Saharan Africa: A Scoping Review

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