Spinal trauma in Tanzania: current management and outcomes

Area of Science:

• Orthopedic Surgery
• Neurosurgery
• Trauma Surgery

Background:

• Spinal trauma is a significant global cause of disability, with a disproportionately high burden in low-income countries due to limited healthcare infrastructure.
• There is a critical lack of data regarding the incidence, management, and outcomes of spinal trauma in East Africa.
• Tanzania, like other East African nations, faces challenges in managing spinal trauma effectively.

Purpose of the Study:

• To comprehensively describe the demographics, management strategies, surgical costs, and treatment decision factors for spinal trauma patients in Tanzania.
• To analyze the outcomes of spinal trauma patients, focusing on neurological recovery.
• To identify factors influencing positive outcomes in spinal trauma management within the Tanzanian context.

Main Methods:

• Retrospective review of prospectively collected data from a single surgical referral center in Tanzania (Muhimbili Orthopaedic Institute) between October 2016 and December 2017.
• Collection of patient demographics, trauma details (mechanism, distance to center, time to surgery), American Spinal Injury Association Impairment Scale (AIS) scores, and surgical information.
• Analysis of surgical outcomes, complications, and prediction of factors for improved neurological status.

Main Results:

• 180 spinal trauma patients were analyzed, with a mean admission delay of 5.9 days and a mean time to surgery of 33.2 days.
• Young males (82.8%) were predominantly affected, often due to motor vehicle accidents (28.9%) or falls from height (32.8%).
• Surgery was associated with improved neurological status (AIS grade improvement) at discharge (21.4%), with prompt surgery being a key predictor of positive outcomes.

Conclusions:

• This study provides the first insights into spinal trauma management and outcomes in East Africa, highlighting late presentations and delayed surgical interventions.
• Surgical intervention, particularly when performed earlier, appears to positively influence neurological recovery in spinal trauma patients.
• The findings underscore the need for evidence-based protocols and improved healthcare infrastructure to optimize spinal trauma management in resource-limited settings.