Ikwuegbuenyi Chibuikem A, Waterkeyn François, Okembo Arthur, Bureta Costansia, Kassim Kassim O, Shabani Hamisi K, Zuckerman Scott, Härtl Roger
Department of Neurological Surgery, New York Presbyterian Hospital/Och Spine, Weill Cornell Medicine, New York, NY, USA.
Division of Neurosurgery, Muhimbili Orthopedic and Neurosurgery Institute, Dar es Salaam, Tanzania.
Int J Spine Surg. 2024 May 6;18(2):186-198. doi: 10.14444/8575.
Trauma to the thoracic, thoracolumbar (TL), and lumbar spine is common and can cause disability and neurological deficits. Using a cohort of patients suffering from thoracic, TL, and lumbar spine trauma in a tertiary hospital in East Africa, the current study sought to: (1) describe demographics and operative treatment patterns, (2) assess neurologic outcomes, and (3) report predictors associated with undergoing surgery, neurologic improvement, and mortality.
A retrospective cohort study of patient records from September 2016 to December 2020 was conducted at a prominent East Africa referral center. The study collected data on demographics, injury, and operative characteristics. Surgical indications were assessed using the AO () TL fracture classification system and neurological function. Logistic regression analysis identified predictors for operative treatment, neurologic improvement, and mortality.
The study showed that 64.9% of the 257 TL spine trauma patients underwent surgery with a median postadmission day of 17.0. The mortality rate was 1.2%. Road traffic accidents caused 43.6% of the injuries. The most common fracture pattern was AO Type A fractures (78.6%). Laminectomy and posterolateral fusion were performed in 97.6% of the surgical cases. Patients without neurological deficits (OR: 0.27, 95% CI: 0.13-0.54, < 0.001) and those with longer delays from injury to admission were less likely to have surgery (OR: 0.95, 95% CI: 0.92-0.99, = 0.007). The neurologic improvement rate was 11.1%. Univariate analysis showed a significant association between surgery and neurologic improvement (OR: 3.83, 95% CI: 1.27-16.61, < 0.001). However, this finding was lost in multivariate regression.
This study highlights various themes surrounding the management of TL spine trauma in a low-resource environment, including lower surgery rates, delays from admission to surgery, safe surgery with low mortality, and the potential for surgery to lead to neurologic improvement.
Despite challenges such as surgical delays and limited resources in East Africa, there is potential for surgical intervention to improve neurologic outcomes in thoracic, TL, and lumbar spine trauma patients.
胸段、胸腰段（TL）和腰椎创伤很常见，可导致残疾和神经功能缺损。本研究以东非一家三级医院中患有胸段、胸腰段和腰椎创伤的患者队列，旨在：（1）描述人口统计学特征和手术治疗模式；（2）评估神经学结果；（3）报告与接受手术、神经功能改善和死亡率相关的预测因素。
在东非一家著名的转诊中心对2016年9月至2020年12月的患者记录进行回顾性队列研究。该研究收集了有关人口统计学、损伤和手术特征的数据。使用AO（）TL骨折分类系统和神经功能评估手术指征。逻辑回归分析确定了手术治疗、神经功能改善和死亡率的预测因素。
该研究表明，257例胸腰段脊柱创伤患者中有64.9%接受了手术，入院后中位天数为17.0天。死亡率为1.2%。道路交通事故导致43.6%的损伤。最常见的骨折类型是AO A型骨折（78.6%）。97.6%的手术病例进行了椎板切除术和后外侧融合术。无神经功能缺损的患者（比值比：0.27，95%置信区间：0.13 - 0.54，<0.001）以及从受伤到入院延迟时间较长的患者接受手术的可能性较小（比值比：0.95，95%置信区间：0.92 - 0.99，=0.007）。神经功能改善率为11.1%。单因素分析显示手术与神经功能改善之间存在显著关联（比值比：3.83，95%置信区间：1.27 - 16.61，<0.001）。然而，这一发现在多变量回归中消失了。
本研究突出了在资源匮乏环境中胸腰段脊柱创伤管理的各种主题，包括较低的手术率、从入院到手术的延迟、低死亡率的安全手术以及手术导致神经功能改善的可能性。
尽管东非存在手术延迟和资源有限等挑战，但手术干预有可能改善胸段、胸腰段和腰椎创伤患者的神经学结果。
