Darko Kwadwo, Shukla Ishav, Hassan Taimur, Mirahmadi Eraghi Mohammad, Haider Muhammad Ammar, Guirguis Mina, Farid Michael, Odiase Peace, Barrie Umaru, Aoun Salah G, Banson Mabel, Totimeh Teddy
1Department of Neurosurgery, Korle Bu Teaching Hospital, Accra, Ghana.
2Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
J Neurosurg Spine. 2024 Dec 20;42(3):261-272. doi: 10.3171/2024.8.SPINE24614. Print 2025 Mar 1.
Traumatic spinal injury (TSI) involves diverse etiologies, posing different risks among patient populations worldwide. Discrepancies in TSI treatment and outcomes between high-income countries and low- and middle-income countries highlight the critical necessity for tailored management approaches for this global challenge. This study delves into the presentation, management, and outcomes of TSI in Africa.
A systematic review of the literature using PubMed, Google Scholar, and Web of Science electronic databases was completed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify articles describing spine trauma in Africa.
In total, 105 articles comprising 74 retrospective/prospective studies and 31 case reports/series with 11,639 patients from 16 African countries were included. Among retrospective/prospective studies, most patients were male (8543/10,538 [81.1%]) with an estimated mean (95% CI) age of 34.5 (32.6-36.3) years. Mechanism of injury included road traffic accidents (RTAs) (mean [95% CI] 49.5% [42.9%-56.0%]) followed by falls (23.2% [18.21%-28.3%]), with most injuries occurring at the cervical spine level (51.6% [44.3%-58.9%]). Regionally, cervical, thoracic, and lumbar injuries were predominant in West (mean [95% CI] 58.6% [45.3%-70.9%]), Southern (54.4% [44.3%-63.9%]), and East (23.0% [11.9%-34.8%]) Africa, respectively. Mean (95% CI) time from injury to presentation was 60.8 (23.0-98.6) hours, and the mean distance to a healthcare facility was 272.6 (220.8-324.4) km (5 articles). Of the 48 articles detailing management approaches, approximately 31.9% (95% CI 21.7%-42.2%) opted for surgery, whereas 64.1% (53.7%-74.4%) pursued conservative treatment. Overall, clinical improvement was reported in 34.1% (95% CI 26.6%-41.6%) (44 articles) of patients at last follow-up, with an estimated mortality rate of 12.1% (9.3%-15.0%) (55 articles). Regionally, clinical improvement in patients was highest in Southern Africa (39.1% [95% CI] 23.2%-55.0%), whereas West Africa had the highest mortality rate (16.9% [10.7%-23.1%]).
The authors' review reveals that TSI in Africa is primarily caused by RTA. Significant challenges exist such as delays in access to care and surgical capacity. Regional differences in injury mechanisms, management, and outcomes exist and addressing these disparities through targeted interventions is pivotal to enhancing patient outcomes and reducing the burden of TSI in Africa.
创伤性脊髓损伤（TSI）病因多样，在全球患者群体中存在不同风险。高收入国家与低收入和中等收入国家在TSI治疗及结果方面的差异凸显了针对这一全球挑战制定个性化管理方法的迫切必要性。本研究深入探讨非洲TSI的表现、管理及结果。
根据系统评价和Meta分析的首选报告项目（PRISMA）指南，使用PubMed、谷歌学术和科学网电子数据库对文献进行系统评价，以识别描述非洲脊柱创伤的文章。
共纳入105篇文章，包括74项回顾性/前瞻性研究和31篇病例报告/系列，涉及来自16个非洲国家的11639例患者。在回顾性/前瞻性研究中，大多数患者为男性（8543/10538 [81.1%]），估计平均（95%CI）年龄为34.5（32.6 - 36.3）岁。损伤机制包括道路交通事故（RTA）（平均[95%CI] 49.5% [42.9% - 56.0%]），其次是跌倒（23.2% [18.21% - 28.3%]），大多数损伤发生在颈椎水平（51.6% [44.3% - 58.9%]）。在区域上，颈椎、胸椎和腰椎损伤分别在西非（平均[95%CI] 58.6% [45.3% - 70.9%]）、南非（54.4% [44.3% - 63.9%]）和东非（23.0% [11.9% - 34.8%]）最为常见。从受伤到就诊的平均（95%CI）时间为60.8（23.0 - 98.6）小时，到医疗机构的平均距离为272.6（220.8 - 324.4）千米（5篇文章）。在48篇详细描述管理方法的文章中，约31.9%（95%CI 21.7% - 42.2%）选择手术，而64.1%（53.7% - 74.4%）采用保守治疗。总体而言，在最后一次随访时，34.1%（95%CI 26.6% - 41.6%）（44篇文章）的患者报告有临床改善，估计死亡率为1十二点一%（9.3% - 15.0%）（55篇文章）。在区域上，南非患者的临床改善率最高（39.1% [95%CI] 23.2% - 55.0%），而西非的死亡率最高（16.9% [10.7% - 23.1%]）。
作者的综述表明，非洲的TSI主要由RTA引起。存在诸如获得医疗服务延迟和手术能力等重大挑战。在损伤机制、管理和结果方面存在区域差异，通过有针对性的干预措施解决这些差异对于改善非洲患者的治疗结果和减轻TSI负担至关重要。
