Departments of1Neurological Surgery and.
2Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania.
J Neurosurg Spine. 2019 Apr 5;31(1):103-111. doi: 10.3171/2018.12.SPINE18635. Print 2019 Jul 1.
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.
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.
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).
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.
脊柱创伤是全球残疾的主要原因。在低收入国家，其负担尤其严重，这些国家医院基础设施较差，资源有限，病例数量较高。目前，东非尚无关于脊柱创伤发生率、处理和结局的可靠数据。本研究的主要目的是首次描述坦桑尼亚脊柱创伤患者的人口统计学、处理、手术和植入物费用、治疗决策因素以及结局。
作者回顾性分析了 2016 年 10 月至 2017 年 12 月期间坦桑尼亚唯一的外科转诊中心（姆希比利骨科研究所）脊柱创伤患者的前瞻性收集数据。他们收集了一般人口统计学信息和以下信息：创伤部位到中心的距离、美国脊髓损伤协会损伤分级（AIS）、手术时间、类固醇使用情况以及创伤机制和 AOSpine 分类和费用。记录了手术细节和并发症。主要结局是出院时的神经功能状态。作者分析了手术结局，并确定了阳性结局的预测因素。
本研究共纳入并分析了 180 例患者。创伤部位到 MOI 的平均距离为 278.0 公里，入院平均时间为创伤后 5.9 天。年轻男性受影响最大（82.8%为男性，平均年龄 35.7 岁）。入院时，47.2%的患者 AIS 分级为 A。最常见的损伤机制是机动车事故（28.9%）和高处坠落（32.8%）。40%的入院患者接受了手术。手术平均时间为 33.2 天；21.4%在出院时 AIS 分级改善的手术患者（p = 0.030）。总体而言，唯一与神经功能状态改善相关的因素是手术（p = 0.03）和手术时间更短（p = 0.02）。
这是第一项描述东非脊柱创伤处理和结局的研究。由于缺乏转诊医院，患者在创伤后很晚才入院，常伴有严重的神经功能缺损。尽管进行了手术，但通常在住院期间较晚进行。手术决策和时间受到植入物供应和经济因素（如保险状况）的严重影响。可能从手术中获益最大的不完全损伤患者未被优先考虑。作者的结果表明，手术可能对患者结局产生积极影响。需要更大样本量的进一步研究来证实我们的结果。这些结果为实施脊柱创伤管理的循证方案提供了有力支持。
