Review of Subaxial Cervical Spine Injuries Presenting to a Tertiary-Level Hospital in Nepal: Challenges in Surgical Management in a Third World Scenario

Abstract

Study Design: Epidemiological retrospective study. Objective: To describe the demographics, timing to surgery, delay, short-term neurological recovery, and complications in surgically treated subaxial cervical trauma in a resource-constrained country. Methods: Thirty consecutive subaxial cervical trauma patients presenting to a trauma hospital in Nepal between December 2015 and August 2017 were analyzed as a retrospective cohort. Patients were segregated into 4 groups based on the timing to surgery: within 2 days, 3 to 7 days, 8 to 30 days, and >31 days. Results: There were 27 male and 3 female patients with mean age 40 years. Twenty-four sustained fall injury, and 27 patients were from outside Kathmandu. No patients were treated within the first 48 hours; only 9 were treated between 3 and 7 days, 16 between 8 and 30 days, and 5 a month later. Major delay was finance and operating room availability. Thirteen patients had a C6C7 involvement followed by C5C6 in 6 patients. Seven patients had complete neurological deficit while 18 patients had incomplete deficit. A total of 46.7% improved their neurology in 6 months. No neurological recovery was observed in complete deficit patients. Conclusion: Seventy percent of our patients were treated longer than 1 week after injury, which would likely be considered unacceptable in most first world countries. As expected, the outcomes for many of these patients were far worse than reported in North American centers with early access to medical care and insurance. Despite this, nearly half of our patients improved neurologically following treatment; hence, surgery holds hope of some restoration of neurologic deficits.

Outcome of Cervical Spine Trauma Patients Admitted to the Intensive Care Unit at a Tertiary Government Referral Trauma Center in Nepal

“…7 Our study shows male predominance (Table 1) which is similar to studies conducted in resource constrained nations. 2,8,15 However it differs from another study where SCI was seen to affect ages between 20 to 39 years. 3 The difference could be due to inclusion of only cervical SCIs in our study.…”

Epidemiology of traumatic spinal cord injury in Nepal: A systematic review

“…Out of 1796 patients, 1315 (73.2%) were male and 481 (26.8%) were female with male to female ratio of 2.8:1. The study with the highest male population (90%) was seen in the study by Dhakal et al 18 In the study of population who suffered spinal trauma after earthquake, however, the number of female was higher, accounting for 56%. 14 The composite mean age of patient in all studies was 40 years with the mean age ranging from 32 19 to 47.5 years.…”

“…Comparing the studies before and after 2017, a significant shift to surgical management in recent years was observed. Only 25.4% of 1312 patients were managed surgically in the studies before 2017 -Bajracharya et al 13 Shrestha et al 16 and Devkota et al 20 But, in the studies after 2017 which included a total of 437 patients, 14,15,17,18,21 the share of surgically managed patients was found to be 76.7%. 17,18 with a cumulative total patients to improve by one ASIA grade being 105 (32%) in all four studies.…”

“…In terms of the setting, one study was done in BP Koirala Institute of Health Sciences (BPKIHS), Dharan; 13 two in Spinal Injury Rehabilitation Centre (SIRC), Kavre; 14,16 two in National Trauma Centre (NTC), Kathmandu; 17,18 one in College of Medical Sciences (COMS) Chitwan; 15 one in Green Pasture Hospital and Rehabilitation Centre (GPHRC), Pokhara; 19 one in Gandaki Medical College (GMC), Pokhara; 20 and one in Nobel Medical College (NMC), Biratnagar. 21 None of them represent studies from the western part of Nepal.…”

“…Only two of the included studies 17,18 mentioned the duration of trauma to hospital arrival. Of the total 121 patients in those studies, 62% arrived within 2 days followed by 29% within 3 days to 7 days, and the remaining 9 % patients arrived after 7 days of trauma.…”