Surgery for Spinal Trauma: Early Days at a Young Institution in a Hilly State

Abstract

Background Spinal trauma is associated with significant morbidity and affects the overall quality of life of the patient as well as their family. The aim of this study was to study the epidemiology, in-hospital outcome, and follow-up of patients undergoing surgery for spinal trauma.

Methods All patients who underwent surgery for spinal trauma at the Department of Neurosurgery between June 2016 and October 2019 were studied retrospectively. Data collected from patient record included demographic profile, mode of injury, level of injury, neurological status at admission, time from injury to operative intervention, hospital stay, neurological outcome at discharge, and follow-up. Postoperative computed tomography scans were done in all patients to check for adequacy of screw placement.

Results A total of 70 patients (45 males, 25 females) with a mean age of 36 years (range: 16–65 years) were operated for spinal injuries at our department during the study period. Fall was the most common mode of injury (77.1%), followed by road traffic accident (28.5%). Most common site of injury was lumbar spine (38.6%), followed by dorsal (32.9%) and cervical (28.5%). Out of the total, 27.1% of our patients were American Spinal Injury Association (ASIA) grade A at presentation whereas 18.6% were ASIA E. Remaining 54.3% patients had incomplete injuries (ASIA B, C, and D). Burst fracture was the most common morphology of injury (60%), followed by translational injuries (30%). Mean duration between injury and operative intervention was 20.8 days. The mean duration of hospital stay was 21.4 days (range: 8–90 days). Six patients expired during hospitalization. All these six cases had cervical spinal injury. One patient of dorsal spine injury with a complete neurological injury expired 6 months after discharge from the hospital (cause unknown). Nine of our cases showed neurological improvement on follow-up and in rest of the patients, neurological status remained same as preoperative status.

Conclusion Neurological status at admission (ASIA grade) and level of injury remain the most important predictor of the outcome. Spinal injury patients must be managed with a holistic and multidisciplinary approach. Rehabilitation is important for helping these patients in leading a productive life.

Keywords

spinal trauma - mode of injury - morphology - ASIA grade - outcome

Publication History

Article published online:
18 June 2020

• References

• 1 Mathur N, Jain S, Kumar N, Srivastava A, Purohit N, Patni A. Spinal cord injury: scenario in an Indian state. Spinal Cord 2015; 53 (05) 349-352
• 2 Srivastava RN, Singh A, Garg RK, Agarwal A, Raj S. Epidemiology of traumatic spinal cord injury: a SAARC perspective. Int J Biochem Mol Biol 2015; 3: 9-22
• 3 Parsons KC, Lammertse DP. Rehabilitation in spinal cord disorders. 1. Epidemiology, prevention, and system of care of spinal cord disorders. Arch Phys Med Rehabil 1991; 72 (4-S) S293-S294
• 4 Lan C, Lai JS, Chang KH, Jean YC, Lien IN. Traumatic spinal cord injuries in the rural region of Taiwan: an epidemiological study in Hualien county, 1986-1990. Paraplegia 1993; 31 (06) 398-403
• 5 Hoque MF, Grangeon C, Reed K. Spinal cord lesions in Bangladesh: an epidemiological study 1994-1995. Spinal Cord 1999; 37 (12) 858-861
• 6 Chacko V, Joseph B, Mohanty SP, Jacob T. Management of spinal cord injury in a general hospital in rural India. Paraplegia 1986; 24 (05) 330-335
• 7 Donovan WH. Donald Munro lecture. Spinal cord injury–past, present, and future. J Spinal Cord Med 2007; 30 (02) 85-100
• 8 Singh R, Sharma SC, Mittal R, Sharma A. Traumatic spinal cord injuries in Haryana: an epidemiological study. Indian J Community Med 2003; 28 (04) 184-186
• 9 Upendra B, Mahesh B, Sharma L. et al. Correlation of outcome measures with epidemiological factors in thoracolumbar spinal trauma. Indian J Orthop 2007; 41 (04) 290-294
• 10 Muzumdar D, Ventureyra ECG. Spinal cord injuries in children. J Pediatr Neurosci 2006; 1: 43-48
• 11 Vale FL, Burns J, Jackson AB, Hadley MN. Combined medical and surgical treatment after acute spinal cord injury: results of a prospective pilot study to assess the merits of aggressive medical resuscitation and blood pressure management. J Neurosurg 1997; 87 (02) 239-246
• 12 Bohlman HH, Freehafer A. Late anterior decompression of spinal cord injuries. J Bone Joint Surg Am 1975; 57: 10-25
• 13 Siddhartha SS, Deepak G, Mahapatra AK. Traumatic paraplegia outcome study at an apex trauma centre. Indian J Neurotrauma 2011; 8 (01) 33-36